ACDF与颈前路混合融合手术治疗三节段脊髓型颈椎病临床疗效观察

Clinical effect analysis of ACDF and anterior cervical hybrid fusion for three-level cervical spondylotic myelopathy

目的比较前路颈椎间盘切除融合术(anterior cervical discectomy and fusion,ACDF)与颈前路混合融合手术治疗三节段脊髓型颈椎病(cervical spondylotic myelopathy,CSM)的临床疗效。方法回顾性分析2019年1月至2021年1月我院手术治疗的58例三节段CSM患者的临床资料,按手术方式为两组,分别行ACDF手术(ACDF组,27例)和ACDF+前路颈椎椎体次全切除融合(anterior cervical corpectomy and fusion,ACCF)手术(混合组,31例)。记录并比较两组患者手术相关指标、并发症发生率、颈椎矢状位参数(C2~7 Cobb角、C2~7 SVA、TIS)及JOA、NDI评分。结果两组患者均顺利完成手术并获得完整随访,随访时间11.5~20.2个月,平均(15.71±1.70)个月。ACDF组手术时间、出血量均少于混合组(P<0.05),术后1个月及末次随访颈椎矢状位参数(C2~7 Cobb角、C2~7 SVA、T1S)改善均优于混合组(P<0.05)。术后1个月混合组JOA评分高于ACDF组,NDI评分低于ACDF组,差异均有统计学意义(P<0.05),至末次随访时两组JOA及NDI评分比较无统计学差异(P>0.05)。两组患者切口均一期愈合,无椎动脉损伤、食管瘘等严重并发症发生。混合组3例患者术后出现一过性吞咽不适异物感,1例术后1个月出现钛网下沉,ACDF组术后2例出现一过性吞咽不适异物感,1例出现C5神经根麻痹症状;两组并发症发生率比较无统计学差异(P>0.05)。结论ACDF与颈前路混合融合手术治疗三节段CSM均能获得良好疗效,但ACDF手术损伤相对较小,在改善患者颈椎矢状位参数方面具有相对优势,而颈前路混合融合手术能早期促进脊髓、神经功能恢复。

Objective To compare the clinical effect of anterior cervical discectomy and fusion(ACDF)and anterior cervical hybrid fusion in the treatment of three-level cervical spondylotic myelopathy(CSM).Methods The clinical data of 58 cases with three-level CSM diagnosed in our hospital from January 2019 to January 2021 were analyzed retrospectively.According to surgical procedures,they were divided into ACDF group(n=27)and hybrid group(n=31),and performed ACDF operation and ACDF+anterior cervical corpectomy and fusion(ACCF)respectively.The operation time,bleeding loss,incidence of complications,the cervical sagittal parameters(C2~7 Cobb angle,C2~7 SVA,T1S)and pre-and post-operative JOA and NDI scores were compared between the two groups.Results All cases completed the surgery successfully,and were followed up for 11.5 to 20.2 months with an average of(15.71±1.70)months.The surgical time and bleeding volume were less,and the cervical sagittal parameters(C2~7 Cobb angle,C2~7 SVA and T1S)were better 1 month after the surgery and at the last follow-up in the ACDF group than those in the hybrid group(P<0.05).The JOA score was higher,and NDI score was lower in the hybrid group than those in the ACDF group 1 month after operation,with statistical differences(P<0.05),but there was no significant difference between the two groups at the last follow-up(P>0.05).All incisions healed in one stage,and no serious complications such as vertebral artery injury and esophageal fistula occurred in both groups.Transient swallowing foreign body sensation was found in 3 cases,and titanium mesh sinking was in 1 case in the hybrid group,and transient swallowing foreign body sensation was in 2 cases,and nerve root palsy of C5 was in 1 case in the ACDF group,and there were no significant difference in complication rate between the two groups(P>0.05).Conclusions Both ACDF and anterior cervical hybrid fusion surgery(ACDF+ACCF)can achieve good outcomes for three-level CSM.However,ACDF surgery has relatively less injury and a relative advantage in improving the sagittal parameters of the patient's cervical spine,anterior cervical hybrid fusion surgery can promote the recovery of spinal cord and nerve function in early stage after surgery.