目的 对比分析前路颈椎间盘切除椎间植骨融合术(anterior cervical discectomy and fusion，ACDF)与前路颈椎椎体次全切除植骨融合术(anterior cervical corpectomy and fusion，ACCF)治疗相邻双节段颈椎病的临床疗效。方法 回顾分析黄山市人民医院2018年1月至2022年6月收治的102例相邻双节段颈椎病患者资料。其中ACDF组50例，男22例，女28例;年龄41～78岁，平均(54。78±10。22)岁;ACCF组52例，男40例，女12例;年龄31～78岁，平均(56。06±10。32)岁。比较两组的围手术期指标、并发症发生率、Odom's分级优良率、疼痛视觉模拟评分(visual analogue scale，VAS)、日本骨科协会(Japan orthopaedic association，JO A)评分、颈椎功能障碍指数(neck disability index，NDI)、颈椎Cobb角、颈椎整体活动度(range of motion，ROM)、上下位相邻节段活动度和相邻节段退变(adjacent segment degeneration，ASD)发生率。结果 术前两组患者VAS、JOA评分及NDI比较差异无统计学意义(P＞0。05)。ACDF组手术时间更短、术中出血量及术后引流量更少、住院时间更短、术后并发症发生率更低(P＜0。05)。术后随访15～22个月，平均(18。23±1。50)个月。两组VAS、JOA评分、NDI较术前均显著改善(P＜0。05);两组间手术优良率、颈椎ROM、上下位相邻节段活动度和ASD发生率比较差异无统计学意义(P＞0。05);ACDF组的颈椎Cobb角大于ACCF组(P＜0。05)。结论 对于相邻双节段颈椎病患者，ACDF、ACCF均有良好的手术疗效，可改善颈椎功能及神经功能，但均存在一定的并发症发生率和相邻节段退变发生率，术后一定程度上减少了颈椎活动度。相比而言，ACDF的优势在于手术创伤小、并发症发生率低、能更好地改善颈椎曲度。
Comparative Study on Efficacy in Treatment of Double-Segmental Cervical Spondylosis with Two Anterior Surgical Approaches
Objective To compare efficacy of anterior cervical discectomy and fusion(ACDF)and anterior cervical corpectomy and fusion(ACCF)in treatment of double-segmental cervical spondylosis.Methods 102 patients underwent surgical treatment for double-segmental cervical spondylosis in Peoples'Hospital of Huangshan City from January 2018 to June 2022 were retrospectively reviewed,and divided into ACDF group and ACCF group,according to surgical approach the patient received.ACDF group comprised 50 patients(22 males and 28 females),mean age of(54.78±10.22)years.ACCF group included 52 patients(40 males and 12 females),mean age of(56.06±10.32)years.Perioperative indexes,incidence rate of complications,excellent and good rate,visual analogue scale(VAS),Japan orthopaedic association(JOA)score,neck disability index(NDI),cervical Cobb angle,cervical range of motion(ROM),ROM of adjacent upper and caudal segments,incidence rate of adjacent segment degeneration(ASD)were compared between the two groups.Results There was no significant difference in preoperative VAS,JOA score,NDI between the two groups(P＞0.05).Operation time,intraoperative blood loss,drainage volume,hospital stay and incidence rate of complications in ACDF group were significantly less than those in ACCF group(P＜0.05).All of the patients were followed up for 15 to 22 months with a mean time of(18.23±1.50)months.VAS,JOA score,NDI improved significantly in both groups(P＜0.05),but there was no significant difference in excellent and good rate,cervical ROM,ROM of adjacent upper and caudal segments and incidence rate of ASD between the two groups at final follow-up(P＞0.05).The cervical Cobb angle in ACDF group was significantly larger than that in ACCF group(P＜0.0 5).Conclusion Both ACDF and ACCF produce a satisfactory operative efficacy in treatment of double-segmental cervical spondylosis,improving cervical and nervous function.However,both two approaches may lead to complications and ASD,partly restrict cervical movement.Comparatively,ACDF is less invasive,causes fewer complications and maintains better cervical curvature.
double-segmental cervical spondylosisdiscectomycorpectomyanterior cervical surgerycervical function
万方数据
维普
