连续双节段颈椎前路杂合手术后邻近节段退变的临床观察

Clinical Observation on Adjacent Segment Degeneration in Two-Level Anterior Cerviical Hvbrid Surgery

目的:观察双节段颈椎前路杂合手术(Hybrid Surgery,HS)术后邻近节段退变(Adjacent Segment Degeneration,ASD)的发生发展。方法:回顾性分析2015年2月至2022年9月行双节段杂合手术的患者49例,根据杂合手术的两种手术方式的相对位置分为颈前路椎间融合术/人工颈椎间盘置换术组(ACDF/ACDR组)和ACDR/ACDF组。术前和末次随访比较两组上下位邻近节段的日本骨科协会(JOA)评分、颈椎生理曲度、颈椎整体活动度(ROM)、颈椎退化程度Rydman分级、颈椎间盘退变Miyazaki分级、邻近节段退变新发率及手术并发症。结果:共纳入ACDF/ACDR组15例,ACDR/ACDF组34例;男27例,女22例;年龄为(60.14±15.16)岁;随访时间为(36.00±12.13)个月。两组患者末次随访的JOA评分显著增加,差异有统计学意义(P<0.05)。术后和术前相比,两组患者的颈椎生理曲度和颈椎整体活动度均无显著变化,差异无统计学意义(P>0.05)。组间比较,两组患者的邻近节段退变新发率差异无统计学意义(P>0.05),总体计算两组患者的下位邻近节段退变新发率为36.7%,比上位邻近节段退变新发率22.4%高,但差异无统计学意义(P>0.05)。结论:多数患者在接受杂合手术前已经存在不同程度的邻近节段退变;杂合手术不同的手术方式选择并不会显著影响术后的症状改善和邻近节段退变的发生发展;杂合手术后的下位邻近节段退变新发率相比上位邻近节段更高,但无显著差异。

Objective:To observe the occurrence and development of adjacent segment degeneration(ASD)after two-level anterior cervical hybrid surgery(HS).Methods:49 patients who underwent double-segment HS from February 2015 to September 2022 were retrospectively analyzed.According to the relative positions of the two surgical methods of HS,it is divided into ACDF/ACDR group and the ACDR/ACDF group.Japanese orthopedic association(JOA)scores,cervical spine physiological curvature,range of motion(ROM),Rydman classification,Miyazaki classification,new incidence rate of ASD and surgical complications of the upper and lower adjacent segments of the two groups were compared before surgery and at the final follow-up.Results:There were 15 cases in the ACDF/ACDR group and 34 cases in the ACDR/ACDF group,27 males and 22 females,age(60.14±15.16)years,follow-up time(36.00±12.13)months.The JOA scores of the two groups at the last follow-up increased significantly.Compared with preoperative and postoperative,there were no significant changes in the physiological curvature and ROM of the cervical spine in the two groups.Comparing between groups,there was no significant difference in the new incidence rate of ASD between the two groups.The overall new incidence rate of ASD in the lower adjacent segments of the two groups was 36.7%,which was higher than the 22.4%new incidence rate of ASD in the upper adjacent segments,but it was not significantly higher.Conclusion:Most patients already have varying degrees of ASD before undergoing HS,different surgical selection methods for HS will not significantly affect the postoperative symptom improvement and the occurrence and development of ASD.The new rate of ASD in the lower adjacent segments after HS tends to be more than that in the upper adjacent segments,but there is no significant difference.