两种前路减压术治疗相邻两节段脊髓型颈椎病的疗效比较

目的比较经椎间隙减压植骨融合术（anterior cervical discectomy with fusion ，ACDF）与椎体次全切减压植骨融合术（anterior cervical discectomy with fusion ，ACCF）对相邻两节段脊髓型颈椎病患者的临床疗效。方法回顾由同一组医师行颈前路手术治疗并成功随访的33例相邻两节段颈椎病患者，根据手术方式分为两组：A组，18例患者行颈前路椎间隙减压联合椎间融合器植骨融合术；B组，15例患者行颈前路椎体次全切除减压联合钛网植骨融合术，比较两组手术时间、术中出血量、住院时间、JOA评分、颈椎曲度变化、融合节段椎间高度及植骨融合情况。结果所有患者均获得随访，时间为12-15个月，平均132个月。A组手术时间长于B组，出血量少于B组，两组参数组间比较差异有统计学意义（P〈0.05）。A组住院天数略少于B组，差异无统计学意义（P〉0.05）。两组术后3天、术后1年随访JOA评分均较术前提高，JOA评分、融合节段高度及颈椎曲度与术前相比差异均有统计学意义（P〈0.05）；但组间JOA评分及颈椎曲度差异比较无统计学意义（P〉0.05），融合节段高度差异有统计学意义（P〈0.05）。两组患者随访期间均未出现内固定松动、断裂等情况。术后1年随访均达到骨性融合的标准。结论两种方法治疗双节段颈椎病均可获得满意的临床疗效，与AcDF相比，AccF视野清楚、操作方便、手术时间短，但手术创伤大、出血量多，在维持融合节段高度方面比AcDF差，存在钛网下沉现象。

A comparison study of two methods for treating two - level cervical spondylitic myelopathy

Objective To compare the clinical effects of anterior cervical diseeetomy with fusion （ACDF） and anterior eetMeul eor- peetomy with fusion（ACCF） for treating adjacent two - level eetwieul spondylitie myelopathy. Methods The dinieul data of 33 patients suf- fered from two -level cervical spondylosis （17 mules and 16 female;age range,45 -70 years;mean age,55 years） who were treated by the same orthopedist with anterior surgical procedures between Aug 2009 and Aug 2012 were retrospectively reviewed. Eighteen of them that un- derwent anterior decompression with cervical bone grafting and fusion with cage made up group A,while other fifteen patients that underwent anterior eetwieul eorpeetomy with preserved posterior vertebrul wull combined with titanium mesh fusion made up Group B. The ewluation in- dex included duration of operation,intraoperative blood loss,the hospitulization duration,Japanese Orthopaedic Assoeiation（JOA） score ewlu- ation,ehange of eervieul vertebrae eurwture（CVC） and intetwertebrul height,situation of fusion after bone trans - plantation. Results All of the patients were followed up for 12 to 15 months with a mean time of 13.2 months. Operative time of group A was less than that of group B （P 〈 0.05）. Volume of loss blood during operation in group B was less than that in group A （P 〈 0.05）. The duration of operation in group A was less than that in group B, but the difference waM statistieully significant （P 〉 0.05） . Postoperative JOA score,the CVC and intetwerte- brul height in 3 days and 12 months were improved （P 〈 0.05） ,whereas there was no significant difference in JOA score and the CVC in ull periods between the two groups （P 〉 0.05）. The eetwieul lordosis in group B was superior to that of group A （P 〈 0.05）. Neither of the groups had implantation loosening or breakage. The spinul fusion rate was 100%. Conclusion Both methods can obtain satisfaetot7 effects in trea- ting two - level eetwieul spondylitie myelopathy. ACCF has advanta