日间管理模式下颈前路椎间盘切除融合术治疗颈椎退变性疾病的安全性及早期临床疗效

Safety and early clinical efficacy of daytime anterior cervical discectomy and fusion(ACDF)in the treatment of cervical degenerative diseases

目的:探究将颈前路椎间盘切除融合术(anterior cervical discectomy and fusion,ACDF)治疗颈椎退变性疾病(cervical degenerative diseases,CDD)纳入日间管理模式的安全性及早期疗效。方法:回顾性分析2022年9月~2023年3月接受日间ACDF手术治疗的12例CDD患者。其中,女性10例,男性2例,年龄53.7±8.6岁(36~67岁),单节段手术8例,双节段手术4例。记录手术时间、术中出血量、术后引流量、出院后30d再入院率及并发症、患者就医满意度等,评价手术安全性及早期临床结果。术前和出院当日采用视觉模拟评分量表(visual analogue scale,VAS)、颈椎功能障碍指数(neck disability index,NDI)、日本骨科协会(Japanese Orthopedic Association,JOA)评分及JOA评分改善率(recovery rate,RR)评估患者疼痛改善情况及神经功能。术后2d,拍摄颈椎X线片、CT及MRI以评估置入物的位置、神经减压情况和颈椎生理曲度。结果:12例患者均手术成功,随访时间2.5±0.8个月(1~6个月),患者疼痛症状及神经功能均有明显改善。手术时间为71.3±20.5min,术中出血量为14.6±8.4mL,术后引流量为8.8±7.3mL。出院当日VAS(2.1±0.9分)、NDI[(22.4±3.5)%]、JOA评分(14.3±1.1分)较术前VAS(6.6±1.7分)、NDI[(66.3±4.7)%]、JOA评分(8.3±1.3分)分别明显改善(P<0.05),JOA评分RR为100%。术后1例患者出现轻度吞咽困难(8.3%),未经特殊处理,症状自行消失。随访期间,无出院后30d内再入院病例,1例患者出院后6d出现切口血肿,患者无呼吸及吞咽困难,经专科检查评估后行加压包扎,4d后自愈。所有患者术后影像学检查显示置入物位置理想,神经减压充分,术后颈椎生理曲度(28.7°±2.0°)较术前(15.7°±4.6°)明显改善(P<0.05)。结论:日间ACDF的安全性及早期疗效较为满意,可为合适的CDD患者提供一种新的手术模式选择。

Objectives:To explore the safety and early efficacy of daytime management model of anterior cervical discectomy and fusion(ACDF)in the treatment of cervical degenerative diseases(CDD).Methods:A retrospective analysis was performed on 12 patients with CDD who underwent daytime ACDF between September 2022 and March 2023.There were 10 females and 2 males,and the patients aged 53.7±8.6 years(36-67 years).8 out of the patients underwent single-segment surgery,a,nd the other 4 underwent double-segment surgery.Visual analogue scale(VAS),neck disability index(NDI),Japanese Orthopedic Association(JOA)score,JOA score recovery rate(RR),operative time,intraoperative blood loss,postoperative drainage,30-day readmission rate,patient satisfaction with medical care,and complication rate were used to assess surgical safety and early clinical outcomes.Cervical X-rays,CT,and MRI examinations were taken to assess the location of implant,nerve decompression condition,and cervical curvature.Results:All the 12 patients were successfully operated and followed up for 2.5±0.8 months(1-6 months).The postoperative pain symptoms and nerve function were significantly improved.The operative time was 71.3+20.5min,the intraoperative blood loss was 14.6±8.4mL,and the postoperative drainage volume was 8.8±7.3mL.VAS(2.1±0.9 points),NDI[(22.4±3.5)%],and JOA score(14.3+1.1 points)on discharge were significantly improved compared with the VAS(6.6±1.7 points),NDI[(66.3±4.7)%],and JOA score(8.3±1.3 points)before operation(P<0.05),and JOA score RR was 100%.One patient had mild dysphagia after operation(8.3%),and the symptom disappeared without any special treatment.During the follow-up period,there was no case of re-admission within 30d after discharge,but 1 patient developed incision hematoma on 6d after discharge,with no difficulty in breathing or swallowing.After specialist examination and evaluation,pressure bandaging was performed,and the patient selfhealed 4 days later.Postoperative imaging examination showed that the position of the implant was ideal,the nerve decompression was sufficient,and the postoperative cervical physiological curvature(28.7°±2.0°)was significantly improved compared with that before operation(15.7°±4.6°)(P<0.05).Conclusions:Daytime ACDF is relatively satisfied in the safety and early efficacy,which can provide a new surgical mode option for suitable patients with CDD.