椎间盘切除术、椎间盘切除植骨融合术及椎间盘切除植骨融合内固定术：前瞻性随机对照研究

神经根型颈椎病患者行前路椎间盘切除术后，是否需行椎体间植骨融合仍存在争议。该研究评价了不同术式包括椎间盘切除术（ACD）、椎间盘切除植骨融合术（ACDF）及椎间盘切除植骨融合内固定术（ACDFI）的临床疗效及影像学表现。42例神经根型颈椎病患者药物治疗失败后被随机分为三组：ACD，ACDF和ACDFI。术前及术后随访时分析指标包括全身情况、[第一段]     

颈前路椎体次全切除与颈前路椎间盘切除植骨融合内固定治疗相邻双节段颈椎病的比较

目的 比较颈前路椎体次全切除植骨融合内固定术(Anterior cervical corpectomy and fusion,ACCF)与颈前路椎间盘切除植骨融合内固定术(Anterior cervical discectomy and fusion,ACDF)治疗相邻双节段颈椎病的矢状面平衡和功能恢复效果。方法 纳入自2018-03—2020-07诊治的143例相邻双节段颈椎病,其中ACCF组76例,ACDF组67例。比较ACCF组与ACDF组手术时间、术中出血量、住院时间,术后6个月JOA评分、NDI指数、疼痛VAS评分,以及术后6个月颈椎矢状面参数。结果 ACCF组随访时间为(6.4±1.0)个月,ACDF组随访时间为(7.1±1.1)个月。ACCF组术后没有出现钛网沉降,术后6个月随访时均获得植骨融合。ACDF组手术时间、住院时间均较ACCF组短,术中出血量较ACCF组少,差异有统计学意义(P<0.05)。ACCF组、ACDF组术后6个月T₁倾斜角、C₂～C₇矢状垂直轴与术前比较差异无统计学意义(P>...     

腰椎后路椎体间采用不同植骨方式的融合效果之比较

目的探讨采用不同的植骨方式对于腰椎后路椎体间融合效果的影响。方法回顾性分析我院1999-2006年间采用后路椎间盘切除,椎间植骨融合 椎弓根螺钉内固定手术治疗的426例病例,通过其术后X线融合率或CT进行效果评价。结果365例获得随访(平均1.7年),术后结果:自体棘突椎板植骨融合率为91.9%,自体髂骨植骨融合率94.0%,异体骨植骨融合率87.5%,椎间融合器融合率94.0%。结论自体棘突椎板植骨是一种可靠,简单有效的植骨融合方式。     

节段内V形棒内固定技术联合峡部植骨融合治疗青少年腰椎峡部裂的疗效观察

目的 探讨节段内V形棒内固定技术联合峡部植骨融合治疗青少年腰椎峡部裂的手术方法和疗效。方法 回顾性分析自2016-10—2020-02采用节段内V形棒内固定技术联合峡部植骨融合治疗的31例青少年腰椎峡部裂,其中单节段峡部裂24例,双节段峡部裂6例,三节段峡部裂1例。共39个峡部裂腰椎,其中A型28个,B型6个,C型5个。A型和B型峡部裂椎体采用节段内V形棒内固定技术联合峡部植骨融合,C型峡部裂椎体采用常规椎体间植骨融合内固定。结果 31例均获得随访,随访时间1.0～3.5年,平均1.4年。术后3个月、6个月、12个月疼痛VAS评分和ODI指数均较术前明显改善,差异有统计学意义（P<0.05）。术后1年随访时,除了5个C型峡部裂椎体行椎间融合术外,其余34个腰椎双侧峡部裂（共计68个峡部裂断面）中25个椎体双侧融合,7个椎体单侧融合,2个椎体未融合,峡部裂融合率为83.8%(57/68)。结论 节段内V形棒内固定技术联合峡部植骨融合治疗青少年腰椎峡部裂可避免腰椎节段间融合或固定,可保留腰椎节段活动度,具有创伤小、神经损伤风险小、术后腰椎稳定性好、植骨融合率高等优点。     

颈前路椎间盘切除融合（ACDF）中密度增高的同种异体植骨块（DCAs）具有较高的植骨块吸收率

本文通过对27例ACDF患者共40个节段采用了同种异体植骨块融合，术后采用CT矢状位三维重建评估植骨块吸收的中央部分和植骨块与椎体桥结部分的骨小梁形成，过伸过屈位X线片评估融合情况。结果发现经过平均15个月的随访（范围为12～26个月），     

颈前路减压两种术式治疗二或三节段颈椎病的比较

目的 比较颈前路减压两种术式(椎间盘切除植骨内固定术和椎体次全切植骨内固定术)治疗2或3节段颈椎病的优缺点,以确定哪种术式更适用于治疗2或3节段颈椎病.方法 回顾性分析自2006年7月～2011年7月行颈前路减压手术治疗2或3节段颈椎病70例,其中行颈椎间盘切除植骨内固定术(ACDF)者38例,椎体次全切植骨内固定术(ACCF)者32例.结果 ACDF组和ACCF组平均随访(15±5.2)、(13±6.2)个月,平均节段失血量ACDF组少于ACCF组(分别80±18.5 ml和193±67.2 ml,P =0.001);平均节段手术时间ACDF组少于ACCF组(分别61.7±16.9 min和83.4±28.2 min,P =0.026);手术相关并发症发生率(分别15.8％和12.5％)和随访期间不良情况发生率(分别5.3％和9.4％),两组比较差异无统计学意义.结论 颈前路手术治疗2或3节段颈椎病,如椎体中部后方无致压物,建议选择椎间盘切除植骨融合内固定术.     

前路减压植骨融合联合钢板置入内固定治疗脊髓型颈椎病的效果分析

<正>我院自2011-06-2014-06对收治的84名脊髓型颈椎病(CSM)患者分别采用前路椎间盘切除植骨融合并钛板置入内固定(anteriorcervical discectomy and fusion,ACDF)和前路椎体次全切除植骨融合并钛板置入内固定(anterior cervical corpectomy and fusion,ACCF)治疗,观察术后疗效,现将结果汇报如下。1资料与方法1.1一般资料选取2011-06-2014-06就诊于我院的84名CSM患者作为研究对象,其中男55例,女29例;年龄     

邻椎取骨移植在颈前路椎间植骨融合术中的应用

目的探讨在颈椎前路椎间盘切除减压椎间植骨融合术(anterior cervical discectomy and fusion,ACDF)术中行邻近椎体取骨移植的可行性、安全性。方法将40例行ACDF手术的患者随机分为观察组和对照组各20例,内固定物均为零切迹椎间融合器(Zero-P)。观察组采用邻椎取骨移植行椎间植骨融合,对照组采用自体骨赘移植行椎间植骨融合。比较两组手术时间、术中出血量、术后引流量、并发症及植骨融合情况,采用VAS评分、JOA评分、颈椎Cobb角和颈椎融合节段椎体前后缘高度比(HAB/HPB)评价疗效。结果两组手术时间、术中出血量、术后引流量比较,差异无统计学意义(P0. 05);两组术后VAS评分、JOA评分、Cobb角和HAB/HPB与术前对比差异显著(P0. 05),但两组间差异无统计学意义(P0. 05)。术后6个月观察组植骨融合率高于对照组,但差异无统计学意义(P0. 05)。两组均未出现神经血管损伤、脑脊液漏、供骨椎体塌陷等并发症。结论邻椎取骨移植与自体骨赘移植在颈前路减压椎间植骨融合术中的疗效基本一致,术后取骨椎体无塌陷,邻椎取骨移植安全有效。     

椎体间融合治疗腰椎间隙狭窄症的临床疗效分析

目的 分析各种椎体间融合术治疗椎间隙狭窄症的临床疗效,及其适应证。方法 采用后路全椎板减压椎体间植骨加节段内固定、后路全椎板减压双Cage植入或加用节段内固定、后路半椎板减压单Cage植入或加用节段内固定、前路椎体问撑开植骨及前路椎体间撑开双Cage植入等术式治疗腰椎间隙狭窄症84例并对疗效、适应证进行分析总结。结果 全部病例随访10-24个月,临床疗效优良率为90．5％,植骨融合率为91．7％(其中自体骨植骨融台率为84．0％,Cage植骨融合率为93．2％),椎问隙恢复高度为11．4mm(其中自体骨恢复高度为10．6mm,Cage恢复高度为11．8mm)。结论 椎体间植骨融合治疗椎间隙狭窄症具有疗效好、植骨融合率高等优点,根据不同病因选择不同术式治疗,能减少损伤、提高疗效、缩短康复时间．     

颈前路椎体间不同融合固定手术的疗效分析

目的:探讨3种不同颈前路椎体间植骨融合固定手术的疗效。方法:83例颈前路手术,男38例,女45例;年龄48~86岁,平均69岁。最高融合椎间隙为C3,4,最低为C7T1;单节段固定48例,双节段固定26例,3节段固定9例;椎体间自体植骨(Robingson植骨)融合固定(A组)46例,椎体间钛网植骨融合固定(Pyramesh)(B组)21例,颈椎间植骨融合器(BAK)固定(C组)16例。结果:83例术后随访6~24个月,平均12个月。采用日本骨科协会(JOA)下腰痛评分标准,术后JOA评分12~17分,平均16.1分,在5个月内评分不断提高,差异有显著性(P<0.01)。骨性愈合时间13~18周。结论:Robingson植骨对颈椎稳定性和骨性融合较可靠,但有增加手术切口和可能发生取骨区并发症的缺点,BAK椎体间融合固定手术的技术要求高,易发生融合器内陷椎间隙高度丢失,Pyramesh融合手术无前者缺陷,不但颈椎稳定性和骨性融合可靠,且手术适应证更广,操作安全简单,但经济费用较高。     

Anterior Interbody Fusion with the BAK-Cage in Cervical Spondylosis

Summary BAK-C is a new autostabilizing interbody cage which is implanted during an anterior cervical procedure to provide stability to the motion segment and allow fusion to occur. Special intrumentation is provided with a bone collecting reamer. The system utilizes surgical site bone graft as the osteo-inductive material within the implant. Biomechanical testing indicates improved stability and animal studies show good fusion. The basic principle is distraction-compression using the tension forces of the annulus fibrosus. Operative material concerns a two years experience with 80 patients (101 levels), 72 with cervical radiculopathy, 8 with myelopathy. Clinical evaluation is assessed on a ten point analogue pain scale for neck and arm/shoulder pain, with neurological examination. Radiological evaluation includes dynamic X-rays, myelo-CT and MRI. Patients are re-evaluated at 1, 6, 12 months postoperatively. Results for neck and radicular pain is excellent, but neurological recovery for radiculopathy and myelopathy is quite different. Radiological results are also good with (except one case) no instability, no cage migration, no kyphosis, no pseudarthrosis. Bone fusion is assessed at 6 and 12 months. Complications are few with proper technique, mainly correct distraction, symmetrical endplate drilling and lateral X-ray control. Only one patient needed an early re-operation with additional miniplate fixation. Immediate stability with good clinical response and no graft morbidity are the advantages of this implant compared to conventional cervical interbody grafting techniques.     

Outcomes of three anterior decompression and fusion techniques in the treatment of three-level cervical spondylosis

The purpose of this article is to compare the outcomes of three different anterior approaches for three-level cervical spondylosis. The records of 120 patients who underwent anterior approaches because of three-level cervical spondylosis between 2006 and 2008 were reviewed. Based on the type of surgery, the patients were divided into three groups: Group 1 was three-level anterior cervical discectomy and fusion (ACDF); Group 2 anterior cervical hybrid decompression and fusion (ACHDF, combination of ACDF and ACCF); and Group 3 two-level anterior cervical corpectomy and fusion (ACCF). The clinical outcomes including blood loss, operation time, complications, Japanese Orthopedic Association (JOA) scores, C2–C7 angle, segmental angle, and fusion rate were compared. There were no significant differences in JOA improvement and fusion rate among three groups. However, in terms of segmental angle and C2–C7 angle improvement, Group 2 was superior to Group 3 and inferior to Group 1 (all P < 0.01). Group 2 was less in operation time than Group 3 (P < 0.01) and more than Group 1 (P < 0.01). Group 3 had more blood loss than Group 1 and Group 2 (all P < 0.01) and had higher complication rate than Group 1 (P < 0.05). No significant differences in blood loss and complication rate were observed between Group 1 and Group 2 (P > 0.05). ACDF was superior in most outcomes to ACCF and ACHDF. If the compressive pathology could be resolved by discectomy, ACDF should be the treatment of choice. ACHDF was an ideal alternative procedure to ACDF if retro-vertebral pathology existed. ACCF was the last choice considered.     

Biomechanical evaluation of subcortical versus bicortical screw purchase in anterior cervical plating

Summary The purpose of this in vitro study is to compare the stabilities provided by anterior cervical H-plating with screws purchased either subcortically or bicortically on porcine cervical spines.Nine porcine cervical spines (C3–C4) were challenged by 12 Nm in extension followed by 6 Nm in flexion in 6 consecutive steps, i.e., (1) when disc was intact, (2) after discectomy. Subsequently, a tricortical bone graft was inserted to simulate interbody fusion. Each specimen was tested again (3) when plated with 16 mm screws to purchase subcortically and (4) after cyclic loading (f=0.5 Hz, n=1000), (5) when plated with 30 mm screws to purchase bicortically and (6) after cyclic loading. Neutral zone and range of motion were parameters normalized for comparison.The results showed comparable stability in constructs plated with screws purchased either subcortically or bicortically before cyclic loading. Cyclic loading deteriorated construct-bone relation in both groups, yet bicortically purchased screws rendered additional stability in anterior cervical plating.     

前路椎间盘切除减压融合与椎体次全切除减压融合治疗多节段颈椎病疗效比较

目的比较前路椎间盘减压融合(ACDF)与前路椎体次全切除减压融合(ACCF)治疗多节段颈椎病的效果。方法将138例多节段脊髓型颈椎病患者按照治疗方式的不同分为观察组(行ACDF治疗)和对照组(行ACCF治疗),比较两组手术时间、术中出血量、术后住院时间、术前与术后6个月颈椎总活动度、颈椎曲度、颈椎节段性高度及JOA评分。结果手术时间:观察组(128.3±32.4)min,对照组(163.2±43.6)min;术中出血量:观察组(161.4±122.5)ml,对照组(319.2±308.7)ml;以上指标观察组均少于对照组(P0.05)。术后住院时间:观察组(8.1±3.6)d,对照组(9.5±4.2)d;术后6个月时JOA评分:观察组(12.1±2.2)分,对照组(11.7±2.1)分;颈椎总活动度:观察组26.6°±7.3°,对照组30.5°±8.1°;以上指标两组间差异无统计学意义(P0.05)。术后颈椎曲度:观察组23.5°±7.4°,对照组16.1°±7.2°;椎间节段性高度:观察组5.6°±0.4°,对照组4.7°±0.8°;以上指标两组比较差异有统计学意义(P0.05)。结论 ACDF较ACCF手术时间短、术中出血量少、颈椎生理弯曲和椎间节段高度恢复更好。     

Evaluation of characteristics and surgical outcomes in cervical spondylotic amyotrophy

Background:

Cervical spondylotic amyotrophy (CSA) is a rare clinical syndrome resulting from cervical spondylosis. Surgical treatment includes anterior cervical decompression and fusion (ACDF), and laminoplasty with or without foraminotomy. Some studies indicate that ACDF is an effective method for treating CSA because anterior decompression with or without medial foraminotomy can completely eliminate anterior and/or anterolateral lesions. We retrospectively evaluated outcome of surgical outcome by anterior cervical decompression and fusion (ACDF).

Materials and Methods:

28 CSA patients, among whom 12 had proximal type CSA and 16 had distal type CSA, treated by ACDF, were evaluated clinicoradiologically. The improvement in atrophic muscle power was assessed by manual muscle testing (MMT) and the recovery rate of the patients was determined on the basis of the Japanese Orthopedic Association (JOA) scores. Patient satisfaction was also examined.

Results:

The percentage of patients, who gained 1 or more grades of muscle power improvement, as determined by MMT, was 91.7% for those with proximal type CSA and 37.5% for those with distal type CSA (P < 0.01). The JOA score-based recovery rates of patients with proximal type and distal type CSA were 60.8% and 41.8%, respectively (P < 0.05). Patient satisfaction was 8.2 for those with proximal type CSA and 6.9 for those with distal type CSA (P < 0.01). A correlation was observed among the levels of improvement in muscle power, JOA score based recovery rate, patient satisfaction and course of disease (P < 0.05).

Conclusion:

ACDF can effectively improve the clinical function of patients with CSA and result in good patient satisfaction despite the surgical outcomes for distal type CSA being inferior to those for proximal type CSA. Course of disease is the fundamental factor that affects the surgical outcomes for CSA. We recommend that patients with CSA undergo surgical intervention as early as possible.     

ACCF联合颈前路减压zero-p椎间植骨融合内固定术治疗多节段脊髓型颈椎病

目的探讨颈前路椎体次全切除减压融合术(ACCF)联合颈前路减压zero-p椎间植骨融合内固定术治疗多节段脊髓型颈椎病的临床疗效。方法回顾性分析自2016-05—2017-07采用ACCF联合颈前路减压zero-p椎间植骨融合内固定术治疗的30例多节段脊髓型颈椎病,比较术前、术后1周及末次随访时JOA评分、颈椎Cobb角、椎间隙高度。结果30例均顺利完成手术并获得完整随访,随访时间平均21.6个月,切口均一期愈合,植骨均骨性愈合,无内固定松动、移位、断裂、伤口感染、声音嘶哑及神经功能加重等并发症。术后1例出现脑脊液漏,2例出现吞咽不适,非手术治疗后均治愈。术后1周与末次随访时JOA评分、颈椎Cobb角、椎间隙高度较术前均明显改善,差异有统计学意义(P<0.05)。末次随访时根据JOA评分改善率评定综合疗效:优12例,良14例,可4例。结论ACCF联合颈前路减压zerop椎间植骨融合内固定术治疗多节段脊髓型颈椎病安全可靠,能够有效地恢复椎间隙高度和颈椎生理曲度。     

重建钢板螺钉在枕颈融合中的应用

目的 探讨重建钢板螺钉在枕颈融合中的应用效果。方法 回顾分析应用重建钢板螺钉固定行枕颈融合5例病人的临床资料和手术效果。结果 术中、术后无并发症发生,经5～18个月的随访,全部病例3个月达到骨性融合,未见钢板折断、拔钉、断钉等。JOA骨髓功能评分分别提高2～5分。结论 运用重建钢板行枕颈融合固定是一种较方便、牢固、经济的方法。     

两种颈椎前路减压融合术治疗脊髓型颈椎病的临床疗效分析

[目的]回顾性分析比较椎间盘切除减压融合术(ACDF)和椎体次全切除减压融合术(ACCF)在治疗相邻两个节段脊髓型颈椎病的临床疗效及影像学数据.[方法]2005年4月～2007年8月,采用ACDF和ACCF治疗相邻两个节段脊髓型颈椎病156例.临床疗效采用日本骨科学会评分系统(JOA评分)对术前、末次随访的临床疗效进行评价.比较两组患者I临床疗效及手术时间、住院大数、术中失血量、颈椎活动度、颈椎曲度及节段性高度.[结果]两组的临床改善优良率无显著性差异(P＞0.05),ACDF组与ACCF组术中平均出血量及手术时间有显著性差异(P＜0.01),ACCF较ACDF增加,而ACCF组术后的节段性高度及颈椎前凸角较ACDF组明显降低(P＜0.01).[结论]ACDF与ACCF均能达到良好的手术疗效,然而ACDF在减少术中出血量、手术时间,改善和维持术后颈椎前凸角度及节段性高度较ACCF作用明显,但ACDF要求技术较高,有较长的学习曲线.     

人工颈椎间盘置换术治疗脊髓型颈椎病的临床观察

[目的]研究确定颈椎人工椎间盘置换术对脊髓型颈椎病的治疗效果。[方法]对2004年1月．2005年8月间于本院行颈椎人工间盘置换术的12例脊髓型颈椎病患者手术前后的Nurick分级，ONDI评分、颈项和上肢疼痛VAS评分进行比较评估，并采用Odom标准评价手术效果。[结果]本组患者术后Odom优良率达100％，术后Nurick分级、ONDI评分、颈项疼痛VAS评分、上肢疼痛VAS评分均较术前有显著意义的提升（P〈0．01）。[结论]对于1～2个节段的脊髓型颈椎病，颈椎人工椎间盘置换术在维持节段运动功能的同时可取得良好的神经减压效果。     

Should long-segment cervical fusions be routinely carried into the thoracic spine? A multicenter analysis

Background Context

Although recommendations for caudal “end level” in posterior cervical reconstruction remain highly variable, the benefits of routine extension of posterior cervical fusions into the thoracic spine remain unclear.