两种手术方式治疗双节段颈椎病疗效的对比分析

Comparison of the clinical efficacy of anterior cervical decompression Zero-P internal fixation under microscope and conventional ACDF in the treatment of two-level cervical spondylosis

目的比较分析显微镜下颈前路减压Zero-P内固定术与传统颈椎前路椎间盘切除减压融合器植入内固定术(anterior cervical discectomy and fusion,ACDF)治疗双节段颈椎病的临床效果。方法回顾性分析2017年4月至2021年4月在南方医科大学附属东莞医院接受前路减压椎间融合术治疗并随访1年以上的86例双节段颈椎病患者的临床资料,根据手术方式的不同分为微创组(41例)和传统组(45例)。微创组行显微镜辅助下颈椎前路减压Zero-P内固定术,传统组行传统颈前路椎间盘切除Cage融合钛板螺钉内固定术。比较两组患者的手术时间、术中出血量、术后引流量及术后住院时间,术前及术后1d、3个月、末次随访时的疼痛视觉模拟量表(visual analogue scale,VAS)评分、日本骨科学会(Japanese Orthopaedic Association,JOA)颈椎功能评分和颈椎功能障碍指数(neck disability index,NDI),末次随访时复查X线片观察椎间融合情况。结果两组均手术顺利,术后随访12~36个月,平均(21.6±6.3)个月。两组手术时间比较差异无显著性(P>0.05),微创组术中出血量、术后引流量、术后住院时间低于传统组,差异有显著性(P<0.05)。术前两组VAS评分、JOA评分及NDI比较差异无显著性(P>0.05);术后1d、3个月及末次随访时两组VAS评分、JOA评分、NDI均明显优于术前,且术后1d、3个月时微创组明显优于传统组,差异有显著性(P<0.05),末次随访时两组VAS评分、JOA评分、NDI差异无显著性(P>0.05)。末次随访时微创组椎间融合率(87.8%)与传统组(86.6%)比较差异无显著性(P>0.05)。结论两种方法治疗双节段颈椎病均可获得良好的效果,其中显微镜辅助下颈椎前路减压Zero-P内固定术在减轻手术创伤、促进术后颈髓功能早期恢复方面更具优势,值得临床应用。

Objective To investigate the clinical efficacy of anterior cervical decompression Zero-P internal fixation under microscope and traditional anterior cervical discectomy and fusion(ACDF)in the treatment of two-level cervical spondylosis.Method The clinical data of 86 patients with two-level cervical spondylosis who received anterior decompression and interbody fusion in Dongguan Hospital Affiliated to Southern Medical University from April 2017 to April 2021 and were followed up for more than 1 year were retrospectively analyzed.The patients were divided into minimally invasive group(n=41)and traditional group(n=45)according to different surgical methods.Microscopically assisted anterior cervical decompression with Zero-P internal fixation was performed in the minimally invasive group,and traditional anterior cervical discectomy with cage fusion plate and screw internal fixation was performed in the traditional group.The operation time,intraoperative blood loss,postoperative drainage volume and postoperative hospital stay were compared between the two groups.The visual analogue scale(VAS)score of pain,Japanese Orthopaedic Association(JOA)cervical function score and cervical disability index(NDI)were measured before operation and at 1d,3 months and the last follow-up.The X-ray film was reexamined at the last follow-up to observe the interbody fusion.Result Both groups finished the surgery successfully,and were followed up for 12-36 months,with average one of(21.6±6.3)months.The difference in the operation time between the two groups had no statistical significance(P>0.05).The intraoperative blood loss,postoperative drainage volume and postoperative hospital stay in the minimally invasive group were lower than those in the traditional group,and the differences had statistical significance(P<0.05).The VAS score,JOA score and NDI of the two groups at 1d,3 months after operation and at the last follow-up were significantly better than those before operation,and the minimally invasive group was significantly better than the traditional group at 1d and 3 months after operation,and the difference was significant(P<0.05),while there was no significant difference in VAS score,JOA score and NDI between the two groups at the last followup(P>0.05).There was no significant difference in the interbody fusion rate between minimally invasive group(87.8%)and traditional group(86.6%)at the last follow-up(P>0.05).Conclusion Both methods can obtain good results in the treatment of two-level cervical spondylosis,of which microscope-assisted anterior cervical decompression and Zero-P internal fixation has more advantages in reducing surgical trauma and promoting early recovery of postoperative cervical spinal cord function,which is worthy of clinical application.