显微镜辅助下扩大ACDF治疗脊髓型颈椎病的短期效果观察

［摘要］ 目的分析显微镜辅助下扩大颈前路椎间盘切除+椎间植骨融合术（anterior cervical discectomy and fusion,ACDF）治疗脊髓型颈椎病的临床效果。 方法回顾性分析138例脊髓型颈椎病患者的临床资料，根据治疗方法不同分为扩大ACDF组68例和传统ACDF组70例。比较2组手术时间、术中出血量、并发症发生率、日本矫形外科学会（Japanese Orthopaedic Association,JOA）评分、椎间撑开指数（intervertebral distraction index，IDI）及3个月时融合率。 结果扩大ACDF组手术时间短于传统ACDF组，并发症发生率低于传统ACDF组（P＜0.05），2组出血量差异无统计学意义（P＞0.05）。扩大ACDF组JOA评分优良率高于传统ACDF组（P＜0.05）。2组术后3个月IDI均低于术后即刻，扩大ACDF组术后即刻和术后3个月IDI均低于传统ACDF组（P＜0.05）。3个月时扩大ACDF组融合率高于传统ACDF组（P＜0.05）。 结论显微镜辅助下扩大ACDF是一种安全有效地治疗颈椎病的手术方式，扩大了颈前路手术的适应证，提高了手术疗效，降低了轴性症状的发生率。

Observation on the short-term curative effect of expanded ACDF in the treatment of cervical spondylotic myelopathy with the aid of microscope

［Abstract］Objective〖HTSS〗To analyze the short-term curative effect of expanded anterior cervical discectomy and fusion（ACDF） in the treatment of cervical spondylotic myelopathy. Methods〖HTSS〗Clinical data of 138 cervical spondylotic myelopathy patients were retrospectively analyzed. All the patients were divided into expanding ACDF group(68 cases) and the traditional ACDF group(70 cases) according to different therapeutic methods. The duration of surgery, intraoperative blood loss, incidence of complications, Japanese Orthopaedic Association（JOA） score, intervertebral distraction index（IDI） and fusion rates were compared between two groups. Results〖HTSS〗Operation time of group B was significantly shorter than group A(P＜0.05), and complication rate of group B was significantly shorter than group A(P＜0.05), but bleeding amount of two groups showed no significant difference(P＞0.05). The JOA score of expand ACDF was higher than that of traditional ACDF group（P＜0.05）. The IDI of the two group showed a reduce compare to immediately postoperative. IDI of group A were significantly greater than group B, both showed immediately postoperative and 3 months after（P＜0.05）. The fusion rate(P＜0.05) of group B was significantly superior to group A3 after 3 months. Conclusion〖HTSS〗Endoscope-assisted expand ACDF surgery is a safe and effective surgery for the treatment of cervical spondylosis. This operation can enlarge the operative indications of anterior portion, improve the surgical curative effect, and can reduce the incidence of the axial symptoms.