两种颈椎前路融合术治疗双节段脊髓型颈椎病的临床疗效与影像学分析
Two types of anterior cervical fusion for the treatment of two-segment cervical spondylotic myelopathy:clinical efficacy and imaging analysis
方威 1徐士刚 1刘刚2
作者信息
- 1. 南通大学杏林学院附属南京江北医院骨科,江苏南京 210048
- 2. 宿州市第一人民医院骨科,安徽宿州 234000
- 折叠
摘要
目的 对比分析颈前路椎间盘切除椎间融合术(ACDF)和颈前路椎体次全切除椎间融合术(ACCF)治疗双节段脊髓型颈椎病的疗效.方法 回顾性分析2020年1月至2022年12月南通大学杏林学院附属南京江北医院收治的58例双节段脊髓型颈椎病患者的临床资料,按手术方式分为ACDF组30例和ACCF组28例,对比分析两组患者围手术期数据(住院时间、术中出血量和手术时间)、临床参数[颈部残疾指数评分(NDI)和疼痛视觉模拟评分(VAS)]和影像学数据(节段角、T1斜率、C2～7矢状位纵轴距、C2～7前凸角和融合率).结果 ACDF组的手术时间[(107.38±12.29)min vs(118.37±11.36)min,t=3.529,P＜0.01]短于 ACCF 组,术中出血量低于ACCF 组[(58.36±24.31)mL vs(77.73±27.51)mL,t=2.846,P＜0.01].两组的术后 NDI 评分及 VAS 评分均低于术前(P＜0.05),但两组差异无统计学意义(P＞0.05).ACDF组术后、末次随访的节段角及C2～7前凸角均较术前显著改善,且优于ACCF组(P＜0.05).两组T,斜率、C2～7矢状位纵轴距、融合率差异无统计学意义(P＞0.05).结论 ACDF在治疗双节段脊髓型颈椎病中,较ACCF创伤更小,且在恢复颈椎生理曲度方面较ACCF更有优势.对于无明显骨性脊髓压迫,ACDF在治疗双节段脊髓型颈椎病中是一种值得选择的术式.
Abstract
Objective To compare the effectiveness of anterior cervical discectomy and fusion(ACDF)and anterior cervical corpectomy and fusion(ACCF)in the treatment of two-level cervical spondylotic myelopathy.Methods Clinical data of 58 patients with two-level cervical spondylotic myelopathy treated from January 2020 to December 2022 at Nanjing Jiangbei Hospital Affiliated to Xinglin College,Nantong University were retrospectively analyzed.Patients were divided into ACDF group(n=30)and ACCF group(n=28)based on the surgical procedure.Perioperative data(hospitalization time,intraoperative blood loss and operation time),clinical parameters[neck disability index(NDI)score and visual analog scale(VAS)score],and imaging data(segmental angle,T1 slope,C2-7 sagittal vertical axis,C2-7 cervical lordosis,and fusion rate)were compared between the two groups.Results The operation time[(107.38± 12.29)minvs(118.37±11.36)min,t=3.529,P＜0.01]and intraoperative blood loss[(58.36±24.31)mL vs(77.73± 27.51)mL,t=2.846,P＜0.01]were lower in the ACDF group than in the ACCF group.Both groups showed significantly decreased NDI and VAS scores postoperatively compared to preoperative scores(P＜0.05),but the difference between the two groups was not statistically significant(P＞0.05).The ACDF group showed significant improvements in segmental angle and C2-7 cervical lordosis postoperatively and at the last follow-up,which were greater than those in the ACCF group(P＜0.05).There was no statistically significant difference in T1 slope,C2-7 sagittal vertical,and fusion rate between the two groups(P＞0.05).Conclusion In the treatment of two-level cervical spondylotic myelopathy,ACDF has less surgical trauma than ACCF and is more advantageous in restoring cervical lordosis.For cases without significant bony spinal cord compression,ACDF is a preferable surgical option for two-level cervical spondylotic myelopathy.
关键词
颈椎前路/脊髓型颈椎病/双节段/椎间融合术/影像学Key words
Anterior cervical approach/Cervical spondylotic myelopathy/Double segment/Interbody fasion/Imaging引用本文复制引用
基金项目
南京市卫生科技发展专项(YKK21213)
出版年
2024
NETL
NSTL
万方数据