连续式和跳跃式颈椎前路椎间盘切除融合术治疗多节段颈椎病

目的探讨连续式和跳跃式颈椎前路椎间盘切除融合术(ACDF)治疗多节段颈椎病的疗效及安全性。方法回顾性分析2013年1月-2018年12月收治的经非手术治疗无效的78例多节段颈椎病患者临床资料,其中36例采用跳跃式ACDF治疗(观察组),42例采用连续式ACDF治疗(对照组)。比较2组手术时间、术中出血量、住院时间等临床指标及并发症发生情况。记录2组C_2~7活动度(ROM)、矢状位垂直距离(SVA)、T₁倾斜角、植骨融合率、邻近及中间保留节段椎间盘退行性变加重率等影像学指标。采用日本骨科学会(JOA)评分及JOA评分改善率评估神经功能改善情况。结果所有手术顺利完成。所有患者随访8~19个月,中位随访时间为13个月。观察组手术时间和术中出血量明显少于对照组,差异有统计学意义(P < 0.05);2组住院时间差异无统计学意义(P > 0.05)。2组术后各随访时间点JOA评分均较术前改善,差异有统计学意义(P < 0.05),组间差异无统计学意义(P > 0.05);2组JOA评分改善率差异无统计学意义(P > 0.05)。2组术后12周C_2~7 ROM较术前降低,SVA及T₁倾斜角较术前增加,差异均有统计学意义(P < 0.05),组间差异无统计学意义(P > 0.05);末次随访时C_2~7 ROM、SVA及T₁倾斜角均较术后12周有所改善,接近术前水平。2组植骨融合率、邻近及中间节段椎间盘退行性变加重率比较,差异无统计学意义(P > 0.05)。2组植骨融合率、邻近及中间节段椎间盘退行性变加重率差异无统计学意义(P > 0.05)。观察组术后发生吞咽困难2例、声音嘶哑1例,并发症发生率为8.33%;对照组术后发生吞咽困难2例,并发症发生率为4.76%;组间差异无统计学意义(P > 0.05)。结论跳跃式ACDF用于经非手术治疗无效的多节段颈椎病患者可获得与连续式ACDF相近的术后疗效及安全性,并能够有效缩短手术时间,减少术中医源性创伤。

Continuous and skipping anterior cervical discectomy and fusion in treatment of multi-level cervical spondylosis

Objective To investigate the clinical efficacy and safety of continuous and skipping anterior cervical discectomy and fusion (ACDF) in the treatment of multi-level cervical spondylosis.Methods The clinical data of 78 patients with multi-level cervical spondylosis who failed to receive conservative treatment from January 2013 to December 2016 were retrospectively analyzed,including 36 patients treated with skipping ACDF (observation group) and 42 patients with continuous ACDF (control group).Clinical indicators,such as operation time,intraoperative blood loss,hospital stay and complications were compared between the 2 groups.Imaging indicators,such as C_2-7 range of motion (ROM),sagittal vertical axis (SVA),T₁ slope,bone graft fusion rate,and degeneration aggravation rate of adjacent and skip segments were recorded.Japanese Orthopaedic Association (JOA) score and JOA score improvement rate were used to evaluate the improvement of neurological function.Results All the operations were successfully completed and the median follow-up time was 13 months with range from 8 to 19 months.The operation time and intraoperative blood loss in the observation group were significantly less than those in the control group,and the differences were statistically significant (P < 0.05).There was no significant difference in hospital stay between the 2 groups (P > 0.05).The JOA scores of 2 groups at each follow-up time point after surgery were improved compared with that before surgery,and the differences were statistically significant (P < 0.05).There was no significant difference in the JOA score at each follow-up time point between the 2 groups (P > 0.05).There was no significant difference in the improvement rate of JOA score between the 2 groups (P > 0.05).At 12 weeks after operation,C_2-7 ROM in the 2 groups decreased,SVA and T₁ slope increased,the differences were statistically significant (P < 0.05),and there was no significant difference between the 2 groups (P > 0.05);at the final follow-up,C_2-7 ROM,SVA and T₁ slope were improved compared with 12 weeks after operation,closing to the preoperative level.There was no significant difference in the bone graft fusion rate and the degeneration aggravation rate of adjacent and skip segments between the 2 groups (P > 0.05).In the observation group,there was dysphagia in 2 cases and hoarseness in 1,and the incidence of complications was 8.33%;in the control group,there were dysphagia in 2 cases,and the incidence of complications was 4.76%;and there was no significant difference between the 2 groups (P > 0.05).Conclusion Skipping ACDF for the patients with multi-level cervical spondylosis failing conservative treatment can obtain similar efficacy and safety as continuous ACDF,and can effectively shorten the operation time and reduce the iatrogenic trauma during surgery.