【摘要】 目的:评价前路单节段椎体切除植骨融合(anterior cervical corpectomy and fusion,ACF)及两节段椎间盘切除植骨融合(anterior cervical discectomy and fusion,ACDF)治疗两节段受累的脊髓型颈椎病(cervical spondyloticmyelopathy,CSM)的效果。方法:23例采用ACDF法(ACDF组),21例采用ACF法(ACF组),评估围手术期并发症的发生率、植骨融合率、生理弧度的情况、神经功能改善率、手术时间、手术出血量。两组患者经13~36个月随访,平均22个月。结果:ACDF组、ACF组围手术期并发症的发生率分别为13.04%、9.523%,两组比较差异无统计学意义(P>0.05);ACDF组、ACF组手术时间分别为(100±20)min、ACF组(134±22)min,手术出血量分别为(105±31)mL(、207±63)mL,两组间比较差异有统计学意义(P<0.01);两组的患者植骨均获得骨性融合,术后JOA评分平均改善率分别为(82.97±15.02)%和(75.60±14.87)%,两组间差异均无统计学意义(P>0.05)。颈椎生理弧度的情况:最后随访时ACDF组Cobb角为(20.22±4.22)°、ACF组Cobb角为(17.86±3.24)°,ACDF组优于ACF组,两组间比较差异有统计学意义(P<0.05);最后随访时Cobb角的丢失情况ACDF组为(2.09±1.47)°,ACF组为(4.38±2.38)°,两组比较有显著的统计学意义(P<0.01)。结论:两个节段的椎间盘切除植骨融合内固定治疗两节段受累的CSM更具合理,更利于脊柱稳定性的即刻重建长期保持,也能更好地维持颈椎的生理弧度,为植骨融合提供稳定的局部力学环境。更多还原

【Abstract】 Objective:To compare the outcomes of two procedure,the anterior cervical corpectomy and fusion(ACF) and the anterior cervical discectomies and fusion(ACDF),which were used to treat two level cervical spondylotic myelopathy(CSM).Methods:Data of two level CSM undergoing the anterior decompression in ACDF(23 cases,the group A) and in ACF(21 cases,group B) from February 2003 to February 2006,All patientes were followed up for 13 months to 26 months(average 22 m) and analyzed.The operative time and blood loss were compared.The incidence of perioperative complications was compared.The cervical lordosis and the rate of fusion were evaluated by the preoperative and postoperative X-ray,and the improvement of the neurological function was evaluated by the mJOA scale.Results:The rate of perioperative complications was 13.04% in the group A,while the incidence of perioperative complications was 9.523% in the group B.There was no significant difference between the two groups(P>0.05).The blood-loss was 50 mL to 180 mL(105±31) in group A,and 125 mL to 350 mL(207±63) in group B.There was significant difference.The operative time of group A was 70 min to 155 min(100±20) and was 90 min to 185 min(134±22)of group B.All the patients in groups A and B developed bony fusion by the end of the follow-up,and there was no significant difference between the two groups(P>0.05).According to the mJOA scale,the amelioration of the neurological function was(82.97±15.02)% in group A and(75.60±14.87)% in group B.There was no significant difference between the two groups(P>0.05).And was(20.22±4.22)°in group A and(17.86±3.24)°in group B after operation,there was significant difference between the two groups(P<0.05).The loss of the cervical lordosis was(2.09±1.47)° in group A and(4.38±2.38)° in group B by the end of the follow-up.There was significant difference between the two group(P<0.01).Conclusion:The anterior decompression in ACDF more rational for the surgical treatment on the two level CSM than in ACF.It can provide an equal decompressive effect but a more stable local mechanical environment right after the surgery and can maintain it well,which is critical for the bony fusion.更多还原