颈椎前路椎体次全切除融合术联合颈椎前路椎间盘切除融合术与颈椎后路单开门椎管扩大椎板成形术治疗多节段脊髓型颈椎病的疗效比较

Comparison of therapeutic effects between anterior cervical corpectomy and fusion combined with anterior cervical discectomy and fusion and posterior single-door laminoplasty in treatment of multilevel cervical spondylotic myelopathy

目的比较颈椎前路椎体次全切除融合术(ACCF)联合颈椎前路椎间盘切除融合术(ACDF)与颈椎后路单开门椎管扩大椎板成形术治疗多节段脊髓型颈椎病(MCSM)的疗效。方法回顾性分析2018年1月—2021年10月收治的66例MCSM患者临床资料,按照手术方式分为前路组(33例)和后路组(33例),前路组采用ACCF联合ACDF治疗,后路组采用颈椎后路单开门椎管扩大椎板成形术治疗。记录并比较2组手术时间、住院时间、术中出血量、并发症发生情况及术后植骨融合情况。采用日本骨科学会(JOA)评分评估2组患者脊髓功能,在手术前后颈椎动力位X线片上测量颈椎活动度(ROM)和颈椎曲度指数(CCI)。结果所有手术顺利完成。前路组术中出血量少于后路组,差异有统计学意义(P<0.05);2组手术时间、住院时间差异无统计学意义(P>0.05)。2组术后各随访时间点JOA评分较术前明显改善,且随着随访时间延长进一步改善;前路组各随访时间点JOA评分较后路组改善更明显;差异均有统计学意义(P<0.05)。2组术后各随访时间点ROM较术前下降,且随着随访时间延长进一步下降;CCI较术前升高,且随着随访时间延长进一步升高;前路组ROM、CCI变化程度较后路组更明显;差异均有统计学意义(P<0.05)。2组植骨融合率及并发症发生率差异无统计学意义(P>0.05)。结论ACCF联合ACDF与颈椎后路单开门椎管扩大椎板成形术治疗MCSM均有确切疗效,安全性相当;但ACCF联合ACDF在改善脊髓功能及影像学指标方面更具优势,手术创伤更小。

Objective To compare the therapeutic effects between anterior cervical corpectomy and fusion(ACCF)combined with anterior cervical discectomy and fusion(ACDF)and posterior single-door laminoplasty in the treatment of multilevel cervical spondylotic myelopathy(MCSM).Methods From January 2018 to October 2021,the data of 66 patients with MCSM were retrospectively analyzed and divided into anterior group(33 cases)and posterior group(33 cases)according to different surgical method.The patients in anterior group were treated with ACCF combined with ACDF,and the patients in posterior group were treated with cervical posterior single-door laminoplasty.Operation time,hospital stay,intraoperative blood loss,complications and postoperative bone graft fusion were recorded and compared between the 2 groups.Japanese Orthopaedic Association(JOA)score was used to evaluate the spinal cord function.Cervical range of motion(ROM)and cervical curvature index(CCI)were measured on cervical dynamic position roentgenographs before and after surgery.Results All the operations were successfully completed.The intraoperative blood loss in the anterior group was less than that in the posterior group,and the difference was statistically significant(P<0.05).There was no significant difference in operation time and hospital stay between the 2 groups(P>0.05).The JOA score of the 2 groups was significantly improved at each follow-up time point,and further improved with the extension of follow-up time;the JOA scores of the anterior group at each follow-up time point improved more significantly than those of the posterior group;the above differences were statistically significant(P<0.05).The ROM in 2 groups decreased at each follow-up time point,and further decreased with the extension of follow-up time;the CCIs at each follow-up time point were higher than that before operation,and further increased with the extension of follow-up time;the changes of ROM and CCI in the anterior group were more obvious than those in the posterior group;the above differences were statistically significant(P<0.05).There was no significant difference in bone graft fusion rate and complication rate between the 2 groups(P>0.05).Conclusions ACCF combined with ACDF and posterior single-door laminoplasty in the treatment of MCSM are both effective and safe.However,ACCF combined with ACDF has more advantages in improving spinal cord function and imaging indexes,and the surgical trauma is less.