前路椎间盘切除减压融合固定治疗两节段脊髓型颈椎病
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摘要
目的观察前路椎间盘切除减压椎间融合器植骨融合钛板内固定术(ACDF)治疗连续型两节段脊髓型颈椎病的疗效。方法采用ACDF治疗38例连续型两节段脊髓型颈椎病患者。在颈椎X线片上测量融合节段Cobb角、融合节段高度,观察植骨融合情况。采用JOA评分对手术前后神经功能进行评估。结果患者均获得随访,时间11～26个月。术后6～8个月椎间隙植骨均获得骨性融合。融合节段Cobb角:术前为5. 7°±3. 4°,术后3 d为8. 8°±2. 7°,末次随访为8. 1°±1. 9°。融合节段高度:术前为53. 2 mm±2. 5 mm,术后3 d为57. 7 mm±3. 3 mm,末次随访为56. 9 mm±2. 6 mm。JOA评分:术前为7. 8分±2. 2分,术后3 d为12. 4分±2. 6分,末次随访时为13. 0分±2. 1分。上述3项指标术后3 d及末次随访与术前比较差异均有统计学意义(P <0. 05),末次随访与术后3 d比较差异均无统计学意义(P> 0. 05)。结论 ACDF治疗连续型两节段脊髓型颈椎病能维持融合节段高度,临床疗效满意。
Objective To investigate the clinical effect of anterior cervical discectomy and fusion( ACDF) in the treatment of two-level adjacent cervical spondylotic myelopathy. Methods Thirty-eight cases of two-level adjacent cervical spondylotic myelopathy were treated by ACDF,imaging studies were performed before and after operation,including fusion segment Cobb angle and fusion segment height,situation of fusion after bone transplantation,JOA score was used to evaluate the clinical effects before and after the operation. Results The 38 cases were followed up,the time ranged from 11 ～ 26 months. Bony fusion was obtained in all patients in 6 ～ 8 months postoperatively.The Cobb angle were 5. 7° ± 3. 4°,8. 8° ± 2. 7°,and 8. 1° ± 1. 9° at the preoperation,3 days after operation and last follow-up,respectively. The preoperative fusion segment height was 53. 2 mm ± 2. 5 mm,3 days after operation,fusion segment height was 57. 7 mm ± 3. 3 mm,at the last follow-up,fusion segment height was 56. 9 mm ± 2. 6 mm.The preoperative JOA score was 7. 8 ± 2. 2,3 days after operation,JOA score was 12. 4 ± 2. 6,at the last follow-up,JOA score was 13. 0 ± 2. 1. Cobb angle,fusion segment height,JOA score showed significantly statistical difference preoperation and postoperative 3 days( P < 0. 05),and there was no significant difference in above items between postoperative 3 days and last follow-up( P > 0. 05). Conclusions ACDF in the treatment of two-level adjacent cervical spondylotic myelopathy can maintain the fusion segment height of cervical spine,which can obtain a satisfactory clinical efficacy.
Objective To investigate the clinical effect of anterior cervical discectomy and fusion( ACDF) in the treatment of two-level adjacent cervical spondylotic myelopathy. Methods Thirty-eight cases of two-level adjacent cervical spondylotic myelopathy were treated by ACDF,imaging studies were performed before and after operation,including fusion segment Cobb angle and fusion segment height,situation of fusion after bone transplantation,JOA score was used to evaluate the clinical effects before and after the operation. Results The 38 cases were followed up,the time ranged from 11 ～ 26 months. Bony fusion was obtained in all patients in 6 ～ 8 months postoperatively.The Cobb angle were 5. 7° ± 3. 4°,8. 8° ± 2. 7°,and 8. 1° ± 1. 9° at the preoperation,3 days after operation and last follow-up,respectively. The preoperative fusion segment height was 53. 2 mm ± 2. 5 mm,3 days after operation,fusion segment height was 57. 7 mm ± 3. 3 mm,at the last follow-up,fusion segment height was 56. 9 mm ± 2. 6 mm.The preoperative JOA score was 7. 8 ± 2. 2,3 days after operation,JOA score was 12. 4 ± 2. 6,at the last follow-up,JOA score was 13. 0 ± 2. 1. Cobb angle,fusion segment height,JOA score showed significantly statistical difference preoperation and postoperative 3 days( P < 0. 05),and there was no significant difference in above items between postoperative 3 days and last follow-up( P > 0. 05). Conclusions ACDF in the treatment of two-level adjacent cervical spondylotic myelopathy can maintain the fusion segment height of cervical spine,which can obtain a satisfactory clinical efficacy.
引文
[1]肖文德,郭东明,钟波夫,等.两种前路手术治疗双节段脊髓型颈椎病的疗效比较[J].临床骨科杂志,2016,19(6):644-647.
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[8]邓雄伟,闵志海,龚雅强,等.颈前路减压融合术结合切除后纵韧带治疗神经根型颈椎病疗效分析[J].中国骨与关节损伤杂志,2012,27(9):814-815.
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[10]任永安.颈椎前路减压椎间植骨融合钛板内固定治疗多节段脊髓型颈椎病[J].临床骨科杂志,2017,20(3):268-271.
[11]王华仁,陈少文,杨焱鑫,等.两种颈前路术式治疗老年患者双节段脊髓型颈椎病的疗效比较[J].中国老年学,2016,36(22):5668-5670.
[12]李宽宽,夏磊,桑亮.增加前路cage融合对颈椎曲度、稳定性及轴性症状的影响[J].中国组织工程研究,2014,18(13):2049-2054.
[13]张涛,王弘,徐宏光,等.颈椎前路椎体次全切与轴性症状的相关性研究[J].皖南医学院学报,2016,35(3):223-225.
[14]周非非,孙宇,张凤山,等.颈椎前路椎间盘切除、植骨融合内固定术治疗脊髓型颈椎病术后轴性症状的前瞻性研究[J].中国脊柱脊髓杂志,2014,24(6):505-509.
[15]成俊,谭均,赵耘,等.椎板切除融合治疗多节段脊髓型颈椎病伴节段不稳[J].临床骨科杂志,2017,20(1):1-4.
[2] Hartmann S,Kavakebi P,Wipplinger C,et al. Retrospective analysis of cervical corpectomies:implant-related complications of one-and two-level corpectomies in 45 patients.[J]. Neurosurg Rev,2018,41(1):285-290.
[3]李连华,刘智,李放,等.间接减压在成人胸腰椎爆裂性骨折中的应用[J].中华创伤骨科杂志,2016,18(9):814-817.
[4]孙兆云,陈伯华,郭新银,等.后路间接减压治疗不同椎管侵占率的胸腰椎爆裂骨折的效果观察[J].中华骨与关节外科杂志,2015(2):135-139.
[5] Song J,Taghavi C E,Hsu D W,et al. Radiological changes in anterior cervical discectomy and fusion with cage and plate construct:the significance of the anterior spur formation sign[J].Spine,2012,37(4):272-279.
[6] Seo J Y,Ha K Y. Fate of posterior osteophytes in fused segments after anterior cervical discectomy and fusion[J]. Spine,2012,37(9):741-747.
[7]洪旭伟,曹国良,蔡耿喜,等.颈前路减压融合术中后纵韧带切除与保留的研究进展[J].广东医学,2015(5):797-799.
[8]邓雄伟,闵志海,龚雅强,等.颈前路减压融合术结合切除后纵韧带治疗神经根型颈椎病疗效分析[J].中国骨与关节损伤杂志,2012,27(9):814-815.
[9] Chin K R,Ghiselli G,Cumming V,et al. Postoperative magnetic resonance imaging assessment for potential compressive effects of retained posterior longitudinal ligament after anterior cervical fusions:a cross-sectional study[J]. Spine,2013,38(3):253-256.
[10]任永安.颈椎前路减压椎间植骨融合钛板内固定治疗多节段脊髓型颈椎病[J].临床骨科杂志,2017,20(3):268-271.
[11]王华仁,陈少文,杨焱鑫,等.两种颈前路术式治疗老年患者双节段脊髓型颈椎病的疗效比较[J].中国老年学,2016,36(22):5668-5670.
[12]李宽宽,夏磊,桑亮.增加前路cage融合对颈椎曲度、稳定性及轴性症状的影响[J].中国组织工程研究,2014,18(13):2049-2054.
[13]张涛,王弘,徐宏光,等.颈椎前路椎体次全切与轴性症状的相关性研究[J].皖南医学院学报,2016,35(3):223-225.
[14]周非非,孙宇,张凤山,等.颈椎前路椎间盘切除、植骨融合内固定术治疗脊髓型颈椎病术后轴性症状的前瞻性研究[J].中国脊柱脊髓杂志,2014,24(6):505-509.
[15]成俊,谭均,赵耘,等.椎板切除融合治疗多节段脊髓型颈椎病伴节段不稳[J].临床骨科杂志,2017,20(1):1-4.