显微镜下ACDF与常规ACDF治疗脊髓型颈椎病的对比分析
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摘要
目的比较显微镜下颈椎前路椎间盘切除融合术(ACDF)与常规ACDF治疗脊髓型颈椎病(CSM)的疗效。方法回顾性分析2016年3月至2017年5月ACDF治疗的57例CSM的临床资料,其中采用显微镜下ACDF治疗28例(显微组),常规ACDF治疗29例(常规组)。结果显微组术中出血量、术后引流量均明显少于常规组(P<0.05)。两组手术时间、住院时间、术后JOA评分、NDI评分、VAS评分均无明显差别(P>0.05)。结论显微镜下ACDF和常规ACDF治疗脊髓型颈椎病均疗效满意,显微镜下ACDF具有出血量少、术后引流量少、视野清晰等优点。
Objective To compare the curative effect of microscope-assisted anterior cervial disectomy(ACDF) on cervical spondylotic myelopathy(CSM) with conventional ACDF. Methods Of 57 patients with CSM, 28 underwent the microscope-assisted ACDF and 29 the conventional ACDF from March, 2016 to May, 2017. The curative effects were analyzed and compared between both the groups. Results The volumes of intraoperative blood loss and postoperative drainage were significantly less in the microscope group than those in the conventional group(P<0.05).There was no significant difference in operation time, hospital stay, Japanese Orthopaedic Association scores, neck disability index and visual analogue scores between the two groups(P>0.05). Conclusion The curative effects of the microscope-assisted ACDF and conventional ACDF on CSM are good. Compared with conventional ACDF, microscope-assisted ACDF has the advantages such as intraoperative less bleeding, less volume of drainage and clear vision of surgical field.
Objective To compare the curative effect of microscope-assisted anterior cervial disectomy(ACDF) on cervical spondylotic myelopathy(CSM) with conventional ACDF. Methods Of 57 patients with CSM, 28 underwent the microscope-assisted ACDF and 29 the conventional ACDF from March, 2016 to May, 2017. The curative effects were analyzed and compared between both the groups. Results The volumes of intraoperative blood loss and postoperative drainage were significantly less in the microscope group than those in the conventional group(P<0.05).There was no significant difference in operation time, hospital stay, Japanese Orthopaedic Association scores, neck disability index and visual analogue scores between the two groups(P>0.05). Conclusion The curative effects of the microscope-assisted ACDF and conventional ACDF on CSM are good. Compared with conventional ACDF, microscope-assisted ACDF has the advantages such as intraoperative less bleeding, less volume of drainage and clear vision of surgical field.
引文
[1] Hankinson HL, Wilson CB. Use of the operating microscope in anterior cervical discectomy without fusion[J]. J Neurosurg, 1975, 43(4):452-456.
[2] Baron EM, Young WF. Cervical spondylotic myelopathy:a brief review of its pathophysiology, clinical course, and diagnosis[J]. Neurosurgery, 2007, 60(1 Supp1 1):S35-S41.
[3] Lebl DR, Hughes A, Cammisa FJ, et al. Cervical spondylotic myelopathy:pathophysiology, clinical presentation,and treatment[J]. HSS J, 2011, 7(2):170-178.
[4] Ono K, Ota H, Tada K, et al. Cervical myelopathy secondary to multiple spondylotic protrusions:a clinicopathologic study[J]. Spine, 1977, 2(2):109-125.
[5]谢冲,金格勒,李忠伟,等.颈前路与后路内固定系统置入治疗多节段脊髓型颈椎病的Meta分析[J].中国组织工程研究,2014,18(17):2762-2769.
[6]郭雄飞,徐峰,李涛,等.责任节段颈后路单开门椎管扩大成形术治疗多节段脊髓型颈椎病[J].中国临床神经外科杂志,2018,23(8):519-522.
[7] Sodeyama T, Goto S, Mochizuki M, et al. Effect of decompression enlargement laminoplasty for posterior shifting of the spinal cord[J]. Spine(Phila Pa 1976), 1999, 24(15):1527-1532.
[8] Wen Z, Lu T, Wang Y, et al. Anterior cervical corpectomy and fusion and anterior cervical discectomy and fusion using titanium mesh cages for treatment of degenerative cervical pathologies:a literature review[J]. Med Sci Monit,2018, 24:6398-6404.
[9]吴信波,范国鑫,顾昕,等.显微镜辅助下行颈前路椎间盘切除植骨融合术(ACDF)治疗神经根型颈椎病的疗效分析[J].中国矫形外科杂志,2016,24(19):1740-1744.
[10]冉春枭,芦健民.显微镜下前路颈椎间盘摘除Cage植骨融合钛板内固定治疗颈椎病:108例回顾性分析[J].中国组织工程研究,2017,21(15):2349-2354.
[11]许进,唐成林. 74例显微镜下前路间盘摘除Cage植骨融合钛板内固定术治疗脊髓型颈椎病疗效观察[J].颈腰痛杂志,2018,39(1):27-30.
[12] Bruneau M, Cornelius JF, George B. Multilevel oblique corpectomies:surgical indications and technique[J]. Neurosurgery, 2007, 61(3Suppl):106-112.
[13] Cavu?o?lu H, Tuncer C, Tanik C, et al. The impact of automatic retractors on the esophagus during anterior cervical surgery:an experimental in vivo study in a sheep model[J].J Neurosurg Spine, 2009, 11(5):547-554.
[2] Baron EM, Young WF. Cervical spondylotic myelopathy:a brief review of its pathophysiology, clinical course, and diagnosis[J]. Neurosurgery, 2007, 60(1 Supp1 1):S35-S41.
[3] Lebl DR, Hughes A, Cammisa FJ, et al. Cervical spondylotic myelopathy:pathophysiology, clinical presentation,and treatment[J]. HSS J, 2011, 7(2):170-178.
[4] Ono K, Ota H, Tada K, et al. Cervical myelopathy secondary to multiple spondylotic protrusions:a clinicopathologic study[J]. Spine, 1977, 2(2):109-125.
[5]谢冲,金格勒,李忠伟,等.颈前路与后路内固定系统置入治疗多节段脊髓型颈椎病的Meta分析[J].中国组织工程研究,2014,18(17):2762-2769.
[6]郭雄飞,徐峰,李涛,等.责任节段颈后路单开门椎管扩大成形术治疗多节段脊髓型颈椎病[J].中国临床神经外科杂志,2018,23(8):519-522.
[7] Sodeyama T, Goto S, Mochizuki M, et al. Effect of decompression enlargement laminoplasty for posterior shifting of the spinal cord[J]. Spine(Phila Pa 1976), 1999, 24(15):1527-1532.
[8] Wen Z, Lu T, Wang Y, et al. Anterior cervical corpectomy and fusion and anterior cervical discectomy and fusion using titanium mesh cages for treatment of degenerative cervical pathologies:a literature review[J]. Med Sci Monit,2018, 24:6398-6404.
[9]吴信波,范国鑫,顾昕,等.显微镜辅助下行颈前路椎间盘切除植骨融合术(ACDF)治疗神经根型颈椎病的疗效分析[J].中国矫形外科杂志,2016,24(19):1740-1744.
[10]冉春枭,芦健民.显微镜下前路颈椎间盘摘除Cage植骨融合钛板内固定治疗颈椎病:108例回顾性分析[J].中国组织工程研究,2017,21(15):2349-2354.
[11]许进,唐成林. 74例显微镜下前路间盘摘除Cage植骨融合钛板内固定术治疗脊髓型颈椎病疗效观察[J].颈腰痛杂志,2018,39(1):27-30.
[12] Bruneau M, Cornelius JF, George B. Multilevel oblique corpectomies:surgical indications and technique[J]. Neurosurgery, 2007, 61(3Suppl):106-112.
[13] Cavu?o?lu H, Tuncer C, Tanik C, et al. The impact of automatic retractors on the esophagus during anterior cervical surgery:an experimental in vivo study in a sheep model[J].J Neurosurg Spine, 2009, 11(5):547-554.