椎体次全切时两种开槽宽度对脊髓型颈椎病的近期疗效分析
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摘要
[目的]探讨分析颈椎前路椎体次全切植骨融合内固定术(ACCF)时使用两种不同开槽减压宽度对脊髓型颈椎病的近期治疗效果。[方法]回归性分析2012年12月~2015年1月在本院行ACCF手术的66例患者的临床效果。其中椎体次全切时采用1.4 cm开槽减压宽度治疗脊髓型颈椎病31例(1.4 cm组),在椎体次全切时采用1.0cm开槽减压宽度治疗脊髓型颈椎病35例(1.0 cm组)。将手术时间、失血量、融合节段前突角(SL)、手术并发症、术前及术后6个月JOA评分、椎体融合率进行统计学分析。[结果]所有患者随访3年。1.4 cm组手术并发症发生率为3.2%,1.0 cm组手术并发症发生率为5.7%,手术并发症发生率两组差异无统计学意义(P=1.000)。尽管1.4cm组和1.0 cm组患者术前JOA评分差异无统计学意义(P=0.858),但术后6个月1.4 cm组患者平均JOA评分显著高于1.0 cm组患者(P=0.01)。1.4 cm组平均失血量和手术时间显著高于1.0 cm组(P<0.01)。根据影像学评估,1.4 cm组术后融合节段前凸角改善显著高于1.0 cm组(P<0.01)。两组患者术后第12周融合率差异无统计学意义(P=0.294)。[结论]ACCF手术时,开槽减压宽度为1.4cm在神经功能恢复、融合节段前凸角比开槽减压宽度为1.0cm有更好的改善,但手术时间延长和失血量增加。
[Objective] To investigate the short-term efficacy of two slot widths in anterior cervical corpectomy and fusion(ACCF) for the treatment of cervical spondylotic myelopathy(CSM). [Methods] The clinical response of 66 patients who underwent ACCF in our hospital from December 2012 to January 2015 was analyzed retrospectively. Among these patients, 31 underwent vertebra corpectomy with a slot width of 1.4 cm(group A) and 35 underwent the surgery with a slot width of 1.0 cm(group B) for the treatment of CSM. Statistical analysis was performed on the time of operation, blood loss volume, lordosis of fused segments, surgical complications, vertebral fusion rate, Japanese Orthopaedic Association(JOA) scores before surgery and at 6 months after surgery, respectively. [Results] All the patients were followed up for 3 years. The incidence of surgical complications showed no significant difference between group A and group B(3.2% vs 5.7%, P = 1.000). The JOA score before surgery showed no significant difference between group A and group B(P = 0.858), but at 6 months after surgery, group A had a significantly higher mean JOA score than group B(P = 0.01). Group A had significantly greater mean blood loss volume and longer time of operation than group B(P <0.01). Radiographic assessment showed that group A had a better improvement in lordosis of fused segments compared with group B(P <0.01). At 12 weeks after surgery, the fusion rate showed no significant difference between the two groups(P = 0.294). [Conclusions] In ACCF, the slot width of 1.4 cm can achieve better improvements in recovery of neurological function and lordosis of fused segments compared with that of 1.0 cm, but it is associated with prolonged time of operation and increased blood loss volume.
[Objective] To investigate the short-term efficacy of two slot widths in anterior cervical corpectomy and fusion(ACCF) for the treatment of cervical spondylotic myelopathy(CSM). [Methods] The clinical response of 66 patients who underwent ACCF in our hospital from December 2012 to January 2015 was analyzed retrospectively. Among these patients, 31 underwent vertebra corpectomy with a slot width of 1.4 cm(group A) and 35 underwent the surgery with a slot width of 1.0 cm(group B) for the treatment of CSM. Statistical analysis was performed on the time of operation, blood loss volume, lordosis of fused segments, surgical complications, vertebral fusion rate, Japanese Orthopaedic Association(JOA) scores before surgery and at 6 months after surgery, respectively. [Results] All the patients were followed up for 3 years. The incidence of surgical complications showed no significant difference between group A and group B(3.2% vs 5.7%, P = 1.000). The JOA score before surgery showed no significant difference between group A and group B(P = 0.858), but at 6 months after surgery, group A had a significantly higher mean JOA score than group B(P = 0.01). Group A had significantly greater mean blood loss volume and longer time of operation than group B(P <0.01). Radiographic assessment showed that group A had a better improvement in lordosis of fused segments compared with group B(P <0.01). At 12 weeks after surgery, the fusion rate showed no significant difference between the two groups(P = 0.294). [Conclusions] In ACCF, the slot width of 1.4 cm can achieve better improvements in recovery of neurological function and lordosis of fused segments compared with that of 1.0 cm, but it is associated with prolonged time of operation and increased blood loss volume.
引文
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[10]何仿,田纪伟,林昊,等.下颈椎骨折脱位手术方式的初步探讨[J].中国矫形外科杂志,2009,17(20):1524-1526.
[11]Okada Y J,Ikata T,Yamada H,et al.Magnetic Resonance Imaging Study on the results of surgery for cervical compression myelopathy[J].Spine,1993,18(14):2024-2029.
[2]Praveen VM,Michael GK,Paul GM,et al.Cervical surgical techniques for the treatment of cervical spondylotic myelopathy[J].J Neurosurg Spine,2009,11(2):130–141.
[3]Bednarik J,Kadanka Z,Dusek L,et al.Presymptomaticspondylotic cervical cord compression[J].Spine(Phila Pa 1976),2004,29(20):2260-2269.
[4]Lenehan B,Boran S,Street J,et al.Demographics of acute admissions to a National Spinal Injuries Unit[J].Eur Spine J,2009,18(7):938-942.
[5]Matsunaga S,Sakou T,Taketomi E,et al.Clinical course of patients with ossification of the posterior longitudinal ligament:a minimum 10-year cohort study[J].J Neurosurg,2004,100(3 Suppl Spine):245-248.
[6]Kanchiku T,Taguchi T,Kaneko K,et al.A correlation between magnetic resonance imaging and electrophysiological findings in cervical spondylotic myelopathy[J].Spine(Phila Pa 1976),2001,26(13):E294-E299.
[7]Majd ME,Vadhva M,Holt RT.Anterior cervical reconstruction using titanium cage with anterior plating[J].Spine,1999,24(15):1604–1610.
[8]Riew KD,Rhee JM.The use of titanium mesh cages in the cervical spine.[J].Clin Orthop,2002,394(394):47–54.
[9]Chuang HC,Cho DY,Chang CS,et al.Efficacy and safety of the use of titanium mesh cages and anterior cervical plates for interbody fusion after anterior cervical corpectomy[J].Surg Neurol,2006,65(5):464–471.
[10]何仿,田纪伟,林昊,等.下颈椎骨折脱位手术方式的初步探讨[J].中国矫形外科杂志,2009,17(20):1524-1526.
[11]Okada Y J,Ikata T,Yamada H,et al.Magnetic Resonance Imaging Study on the results of surgery for cervical compression myelopathy[J].Spine,1993,18(14):2024-2029.