颈前路ACCF术精准治疗多节段脊髓型颈椎病的疗效

目的 分析颈前路椎体次全切除减压融合术(anterior cervical corpectomy decompression and fusion,ACCF)精准治疗多节段脊髓型颈椎病的临床疗效及手术策略.方法 回顾性分析2016年5月～2018年7月本院治疗的36例三节段脊髓型颈椎病患者的临床资料.根据具体的病理特性分两组,A组20例行ACCF联合Zero-p固定术,B组16例行两椎体ACCF术治疗.采用JOA评价评价临床效果,根据颈椎Cobb角、椎间隙高度变化评价矫形效果.结果 所有患者均获随访,A组平均随访(18.6±7.3)个月,B组(20.1±8.2)个月.两组手术时间、术中出血量有显著性差异(P<0.05),A组优于B组.两组术后1个月和末次随访的JOA评分、颈椎Cobb角及椎间隙高度均较术前显著改善(P<0.05),术后JOA评分、颈椎Cobb角及椎间隙高度差异无统计学意义(P>0.05).结论 ACCF联合Zero-p固定术与两椎体ACCF术治疗多节段脊髓型颈椎病均可获得良好的疗效,前者手术时间短、创伤小.术中应严格把握手术适应证,根据具体的病理特性,精准选择手术方式.     

颈椎前路椎体次全切除植骨融合术后钛网沉降的危险因素

目的：分析颈椎前路椎体次全切除植骨融合术（anterior cervical corpectomy and fusion,ACCF）后钛网（titanium mesh cages,TMC）沉降的发生率及其危险因素。方法：回顾性分析北京大学第三医院骨科脊柱组2019年1月～2021年12月期间实施ACCF手术的82例脊髓型颈椎病患者,其中男性44例,女性38例,年龄52.4±10.1岁（34～76岁）,随访时间26.6±12.5个月（6～42个月）。根据术后3个月时融合节段高度下降是否超过2.0mm将患者分为沉降组和未沉降组。在术前、术后1d、术后3个月颈椎侧位X线片上测量C2/C7 Cobb角、手术节段Cobb角、椎体间撑开距离、融合节段高度;在术前颈椎CT上测量手术节段近端及远端椎体的CT值,评估骨质疏松情况,记录术前、末次随访的JOA评分,计算JOA评分改善率;将各变量进行单因素分析,将P<0.1的变量及有临床意义的危险因素纳入Logistic回归分析,通过受试者工作特征（receiver operating characteristic,ROC）曲线评价危险因素预测钛网沉降...     

颈前路经椎间隙扩大锥状减压融合术治疗严重椎间隙狭窄颈椎病的疗效观察

目的：观察颈前路经椎间隙扩大锥状减压融合术（enlarged anterior cervical intervertebral cone-shape decompression and fusion,EACDF）治疗严重椎间隙狭窄颈椎病的临床疗效。方法：回顾性分析2015年1月～2020年7月采用颈椎前路减压融合手术治疗的135例严重椎间隙狭窄颈椎病患者的临床资料,其中53例患者行颈前路椎体次全切减压融合术（anterior cervical corpectomy and fusion,ACCF）,纳入ACCF组;82例患者行EACDF,术中采用撑开扩大椎间隙、切除椎体部分后缘及部分钩椎关节的扩大减压方式,纳入EACDF组。对比两组间患者的年龄、性别、体质指数（body mass index,BMI）,记录两组患者的手术时间、术中出血量、平均住院日,术前和术后即刻、2个月、12个月及末次随访时的颈肩部及上肢疼痛视觉模拟评分（visual analog scale,VAS）、颈椎残障指数（neck disability index,NDI）及日本骨科协会（Japanese Orthopa...     

两种前路手术治疗邻近双节段脊髓型颈椎病的临床效果

目的 :比较双节段前路椎间盘切除减压融合术(anterior cervical discectomy and fusion,ACDF)和单节段前路椎体次全切除减压融合术(anterior cervical corpectomy and fusion,ACCF)对邻近双节段脊髓型颈椎病的治疗结果。方法:对2010年09月~2013年7月应用双节段椎间盘切除减压聚醚醚酮融合器(Polyetheretherketone cage,PEEK cage)植骨融合术及单节段椎体次全切减压钛网植骨融合术进行治疗的54例邻近双节段脊髓型颈椎病患者进行回顾性分析,ACCF组23例,ACDF组31例。比较两组患者基线资料、住院天数、手术时间、出血量、日本骨科协会(Japanese Orthopaedic Association,JOA)评分及疼痛视觉模拟评分(visual analogue score,VAS)的不同。通过测量术前、术后3d、末次随访时的影像学图片,分析两组患者颈椎曲度、融合节段高度及融合率的变化。结果:年龄、性别、病变节段、矢状位序列、植骨材料、住院天数和手术时间两组间差异无统计学意义,ACDF组的出血量显著少于ACCF组(175.4±12.1ml VS 201.3±80.4ml)。ACDF组JOA及VAS评分在术前(13.06±0.81、6.48±1.43)与末次随访时(15.45±1.06、2.97±1.28)比较均有显著统计学意义(P=0.000),ACCF组JOA及VAS评分同ACDF组,术后与术前比较均有统计学意义(P0.05);但组间比较未发现明显差别(P0.05)。两组颈椎曲度和融合节段高度术后3d时较术前均有增加(P0.05),而末次随访时轻度下降(P0.05),ACDF组改善程度明显大于ACCF组(P0.05)。两组均获得了100%的融合率。结论 :在邻近双节段脊髓型颈椎病的手术治疗中,ACDF出血量相对较少,能更好地改善颈椎曲度和维持融合节段高度。     

ACDF与ACCF治疗颈椎病术后内植物沉降的观察

目的 比较颈前路椎间盘切除减压融合内固定术(anterior cervical discectomy and fusion,ACDF)和颈前路椎体次全切除减压融合内固定术(anterior cervical corpectomy and fusion,ACCF)治疗相邻两节段脊髓型颈椎病时的内植物沉降情况.方法 回顾性分析2016年1月～2017年3月收治的43例相邻两节段脊髓型颈椎病患者,常规术后随访时间为1年.随访丢失3例,最后纳入统计:ACDF组20例,ACCF组20例.比较2组融合节段椎体高度、融合节段Cobb角.结果 两组术前JOA、NDI评分与术后比较,差异有统计学意义(P<0.05);术后1年随访时的融合节段高度及Cobb角丢失度,ACDF组为(1.7±1.0)mm和(1.60±0.6)°,ACCF组为(2.8±1.3)mm;(2.44±1.2)°,两组差异有统计学意义(P<0.05).结论 ACDF与ACCF治疗脊髓型颈椎病均能获得较好的效果,但ACDF组的内植物沉降较ACCF组轻.     

多节段脊髓型颈椎病两种减压融合术的比较

[目的]比较前路颈椎体切除融合术(anterior cervical corpectomy and fusion,ACCF)联合前路颈椎间盘切除融合(anterior cervical discectomy and fusion,ACDF)与多节段单纯ACDF治疗多节段脊髓型颈病(cervical spondyloti...     

3节段脊髓型颈椎病前路选择性减压植骨内固定疗效分析

目的探讨采用前路单个椎体次全切除联合单个间隙减压（选择性减压）治疗3节段脊髓型颈椎病的临床疗效。方法采用颈椎前路选择性减压植骨内固定治疗31例3节段脊髓型颈椎病。对于影像学上压迫较重的节段选择单椎体次全切除及上下椎间盘切除,压迫较轻的节段行单间隙减压。结果31例患者术后JOA评分均明显提高,改善率有统计学意义（P〈0．05）。根据Odom临床效果分级,优良率85％。结论选择性节段减压治疗3节段脊髓型颈椎病减压彻底,术后患者手术节段均获得了融合,手术节段高度无明显丢失,恢复的颈椎生理曲度无丢失,恢复了颈椎稳定性,患者术后症状改善满意．此手术是目前治疗3节段脊髓型颈椎病的较好方法,值得临床上推广应用。     

单侧双通道脊柱内镜下后方减压联合颈椎前路椎间盘切除融合术治疗多节段混合型颈椎病二例

目的 总结单侧双通道脊柱内镜下颈椎后路椎间孔切开减压术（unilateral biportal endoscopic posterior cervical foraminotomy,UBE-PCF）联合颈椎前路椎间盘切除融合术（anterior cervical discectomy and fusion,ACDF）治疗2例多节段混合型颈椎病的经验。方法 2022年2月及3月收治2例多节段脊髓型颈椎病、神经根型颈椎病及退行性颈椎滑脱患者。男、女各1例;年龄分别为59、66岁。患者上肢感觉减退、Hoffmann征阳性,影像学检查示颈椎不稳、椎间盘突出以及左侧椎间孔狭窄。全身麻醉下对相应病变节段行ACDF以及UBE-PCF。结果 2例手术时间分别为186、145 min,术后切口Ⅰ期愈合。患者均获随访3个月。术后2 d及3个月疼痛视觉模拟评分（VAS）、颈椎功能障碍指数（NDI）均较术前下降,日本骨科协会（JOA）评分较术前上升。影像学复查示治疗节段神经减压彻底,未出现颈椎不稳。结论 对于伴退行性颈椎滑脱的多节段混合型颈椎病,ACDF联合UBE-PCF能选择性处理不同节段病变,最大程度保留...     

颈前路椎体次全切除钛网植骨锁定钢板内固定术治疗双节段脊髓型颈椎病

目的探讨颈前路椎体次全切除钛网植骨锁定钢板内固定术治疗脊髓型颈椎病的临床疗效。方法对36例双节段脊髓型颈椎病患者采用颈前路椎体次全切除钛网植骨锁定钢板内固定术治疗。对术前和术后6、12个月的JOA评分进行比较,计算术后6、12个月的神经功能改善率,评价术后植骨融合情况。结果 36例均获随访,时间12~18个月。JOA评分:术前为8.8分±1.0分,术后6个月为12.8分±1.6分,术后12个月为13.2分±1.4分,术后6、12个月与术前比较差异均有统计学意义(P0.01)。改善率:术后6、12个月分别为56.6%±9.8%和57.9%±10.1%。术后3个月31例(86.1%)植骨融合,术后6个月36例全部植骨融合。结论颈前路椎体次全切除钛网植骨锁定钢板内固定术治疗双节段脊髓型颈椎病疗效确切。     

ACDF联合ACCF术中运用Solis融合器、颈前路钛板与n-HA/PA66支撑体治疗3节段脊髓型颈椎病

目的探讨颈前路间盘切除减压融合术(Anterior cervical discectomy and fusion,ACDF)联合颈前路椎体次全切除减压融合术(Anterior cervical corpectomy and fusion,ACCF)中运用Solis融合器、颈前路钛板与n-HA/PA66支撑体治疗3节段脊髓型颈椎病的疗效。方法回顾性分析自2015-04—2017-06采用ACDF联合ACCF治疗的46例3节段脊髓型颈椎病,术中联合运用Solis融合器、颈前路钛板与n-HA/PA66支撑体,比较术前与末次随访时的JOA评分、颈椎整体曲度、融合节段Cobb角、融合节段前柱高度。结果 46例均顺利完成手术并获得完整随访,随访时间36～48个月,平均42.1个月。46例切口均一期愈合,术后12个月均获得植骨融合。2例出现一过性吞咽困难,1例出现脑脊液漏,1例出现n-HA/PA66支撑体下沉,对症治疗后均治愈。末次随访时JOA评分较术前高,颈椎整体曲度、融合节段Cobb角、融合节段前柱高度较术前大,差异有统计学意义(P0.05)。末次随访时按JOA评分改善率评价疗效:优17例,良23例,可6例,优良率86.96%。结论 ACDF联合ACCF术中运用Solis融合器、颈前路钛板与n-HA/PA66支撑体治疗3节段脊髓型颈椎病可有效恢复颈椎高度,改善并维持颈椎曲度,减少并发症的发生率。     

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.     

Efficacy of multilevel anterior cervical discectomy and fusion versus corpectomy and fusion for multilevel cervical spondylotic myelopathy: a minimum 5-year follow-up study

Purpose

We evaluated radiologic and clinical outcomes to compare the efficacy of anterior cervical discectomy and fusion (ACDF) and anterior corpectomy and fusion (ACCF) for multilevel cervical spondylotic myelopathy (CSM).

Methods

A total of 40 patients who underwent ACDF or ACCF for multilevel CSM were divided into two groups. Group A (n = 25) underwent ACDF and group B (n = 15) ACCF. Clinical outcomes (JOA and VAS scores), perioperative parameters (length of hospital stay, blood loss, operation time), radiological parameters (fusion rate, segmental height, cervical lordosis), and complications were compared.

Results

Both group A and group B demonstrated significant increases in JOA scores and significant decreases in VAS. Patients who underwent ACDF experienced significantly shorter hospital stays (p = 0.031), less blood loss (p = 0.001), and shorter operation times (p = 0.024). Both groups showed significant increases in postoperative cervical lordosis and achieved satisfactory fusion rates (88.0 and 93.3 %, respectively). There were no significant differences in the incidence of complications among the groups.

Conclusions

Both ACDF and ACCF provide satisfactory clinical outcomes and fusion rates for multilevel CSM. However, multilevel ACDF is associated with better radiologic parameters, shorter hospital stays, less blood loss, and shorter operative times.     

Comparison between anterior cervical discectomy fusion and cervical corpectomy fusion using titanium cages for reconstruction: analysis of outcome and long-term follow-up

Retrospective comparative study of 80 consecutive patients treated with either anterior cervical discectomy fusion (ACDF) or anterior cervical corpectomy fusion (ACCF) for multi-level cervical spondylosis. To compare clinical outcome, fusion rates, and complications of anterior cervical reconstruction of multi-level ACDF and single-/multi-level ACCF performed using titanium mesh cages (TMCs) filled with autograft and anterior cervical plates (ACPs). Reconstruction of the cervical spine after discectomy or corpectomy with titanium cages filled with autograft has become an acceptable alternative to both allograft and autograft; however, there is no data comparing the outcome of multi-level ACDF and single-/multi-level ACCF using this reconstruction. We evaluated 80 consecutive patients who underwent surgery for the treatment of multi-level cervical spondylosis at our institution from 1998 to 2001. In this series, 42 patients underwent multi-level ACDF (Group 1) and 38 patients underwent ACCF (Group 2). Interbody TMCs and local autograft bone with ACPs were used in both procedures. Medical records were reviewed to assess outcome. Clinical outcome was measured by Odom’s criteria. Operative time and blood loss were noted. Radiographs were obtained at 6 and 12 weeks, 6 months, 1 year, and 2 years (if necessary). Early hardware failures and pseudarthroses were noted. Cervical sagittal curvature was measured by Ishihara’s index at 1 year. Group 1 had a mean age 46.2 years (range 35–60 years). Group 2 had a mean age 50.1 years (range 35–70 years).The operative time was significantly lower (P < 0.001) and blood loss significantly higher (P < 0.001) in Group 2 than in Group 1. At a minimum of 1 year follow up, patients in both groups had equivalent improvement in their clinical symptoms. The fusion rates for Group 1 were 97.6 and 92.1% for Group 2. The rates of early hardware failure were higher in Group 2 (2.6%) than in Group 1 (0%). The fusion rates for Group 1 were not significantly higher than Group 2 (P > 0.28). There was one patient in Group 1 and 2 patients in Group 2 with pseudarthroses. Complication rates in Group 2 were not significantly higher (P > 0.341). Cervical lordosis was well-maintained (80%) in both groups. Both multi-level ACDF and ACCF with anterior cervical reconstruction using TMC filled with autograft and ACP for treatment of multi-level cervical spondylosis have high fusion rates and good clinical outcome. However, there is a higher rate of early hardware failure and pseudarthroses after ACCF than ACDF. Hence, in the absence of specific pathology requiring removal of vertebral body, multi-level ACDF using interbody cages and autologous bone graft could result in lower morbidity.     

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。     

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.     

三种颈前路融合术后颈椎前柱高度和Cobb角比较

目的比较3种不同植入物的颈前路椎间盘切除、椎间融合术(anterior cervical discectomy and fusion,ACDF)后颈椎前柱高度和Cobb角的情况.方法 1998年1月～2003年1月,随机选择行ACDF的神经根型颈椎病和脊髓型颈椎病患者共60例,其中男41例,女19例.年龄36～68 岁,平均57岁.病程1～36个月,平均6.2个月.按植入物类型分为自体骨(A组)、自体骨 交锁钢板内固定(B组)及Syncage-C(C组)各20例.术前,术后7 d、3个月及最后1次随访(2年以上)摄X线片,评估3组患者融合节段的颈椎前柱高度、Cobb角及功能恢复情况.结果术后患者均获随访2～7年.未保留终板的A、B组,较保留终板的C组,其融合节段的颈椎前柱高度和Cobb角丢失更明显.术后12例植骨块塌陷、3例植骨块移位和10例颈椎姿势异常,主要发生在A、B组.A、B及C组骨性融合分别为17、19及20例,功能评估示A、B、C组的优良率分别为75%、85%及90%.结论为更好维持颈椎前柱高度和生理曲度,须强调保留椎体终板、重视植骨技术、术前仔细评估患者的骨质疏松程度和必要时选用颈前路交锁钢板固定和/或Syncage-C融合.     

Efficacy of combined anteroposterior fusion with no plate versus anterior fusion alone with cage and plate for multilevel degenerative cervical disease

Background contextMany studies have reported that anterior fusion alone has high rates of complications, such as pseudoarthrosis, graft subsidence, and graft dislodgement, with multisegmental constructs. No previous studies have compared the outcomes of combined anteroposterior fusion with no plate and anterior fusion alone with a cage and plate.PurposeTo compare the efficacy of combined anteroposterior fusion with that of anterior fusion alone for the treatment of multisegmental degenerative cervical disorder.Study designRetrospective study.Patient sampleSixty-two consecutive patients who underwent anterior fusion alone with a cage and plate or combined anteroposterior fusion with no plate for multisegmental (three or more segments) degenerative cervical disease.Outcome measureRadiological and clinical outcome measures.MethodsPatients in group A (n=36) underwent anterior fusion with a cage and plate construct (AFA); patients in group B (n=26) underwent combined anterior fusion with a cage and posterior fusion with a rod/screw construct (CAPF). The degree and maintenance of the correction angle, fusion rates, and adjacent level degeneration were assessed with radiographs. Clinical outcomes were assessed with a visual analog scale (VAS) and Neck Disability Index (NDI) scores, operative time, blood loss, and rates of complications.ResultsThe mean correction angle did not differ significantly between groups, but the loss of correction at final follow-up was greater in group A than group B (p=.001). Compared with group B, group A had a higher incidence of pseudarthrosis (p=.035), cage subsidence (p=.005), hardware-related complications (p=.032), and dysphagia (p=.012). The mean VAS score for arm pain and the mean NDI score were better for group B than group A (p=.0461, .0360), but the mean VAS score for posterior neck pain was better for group A than group B (p=.0352). Group B had greater blood loss and a longer operative time than group A (blood loss: p=.037; operative time: p=.0001).ConclusionsAlthough combined anterior/posterior fusion is associated with a longer operative time and greater blood loss than anterior fusion alone, the combined approach provides better maintenance of sagittal alignment, a higher rate of fusion, a lower incidence of cage subsidence and adjacent level disease, and better VAS and NDI scores.     

Persistent swallowing and voice problems after anterior cervical discectomy and fusion with allograft and plating: a 5- to 11-year follow-up study

Anterior cervical discectomy and fusion is commonly performed for cervical disc disease. Most studies report that swallowing and voice problems after such surgeries tend to resolve with time and are often of minor significance except in the rare cases of recurrent laryngeal nerve palsies. A retrospective review was performed on patients who had anterior cervical discectomy and fusion by a single surgeon more than 5 years prior, to determine the persistence of swallowing and voice problems in them.Seventy-four patients who had anterior cervical discectomy and fusion with allograft and plating an average of 7.2 years prior responded to an invitation to return for a follow-up clinical review. Emphasis was placed on the symptoms of dysphagia and dysphonia, as related to the index surgery. At final review, persistent dysphagia was present in 26 patients (35.1%). This occurred more frequently in females and in younger patients. Dysphonia at final review persisted in 14 patients (18.9%). This also occurred more commonly in females and in patients in whom possible non-union is present in at least one of the levels operated upon. Problems with singing were present in 16 patients (21.6%) postoperatively, occurring more frequently if the C3/4 disc was included in the surgery and in patients who have had a greater total number of anterior cervical surgeries at the time of review. Dysphonia and dysphagia are persistent problems in a significant proportion of patients, even beyond 5 years after anterior cervical spine surgery.The study was performed at the Columbia Spine Centre, Columbia, Missouri, USAPresented at the Cervical Spine Research Society (European Section) Annual Meeting, Porto, Portugal, 30 May to 5 June 2004     

3种前路手术治疗单节段脊髓型颈椎病的中期疗效比较

目的比较分析颈前路椎间盘切除融合术(ACDF)、颈前路椎体次全切除融合术(ACCF)和人工颈椎间盘置换术(CADR)治疗单节段脊髓型颈椎病的中期疗效。方法回顾性分析自2004-01—2012-01行ACDF、ACCF和CADR手术治疗的79例单节段脊髓型颈椎病。ACDF组44例,ACCF组22例,CADR组13例。比较3组手术时间、术中出血量,术后6、60个月VAS评分、JOA评分、NDI指数、SF-12评分及颈椎曲度。结果 79例均获得61~88(69.8±12.7)个月随访。ACDF组与ACCF组植骨融合时间差异无统计学意义(P0.05)。术后6个月时,ACCF组JOA评分均高于ACDF组及CADR组,ACDF组与ACCF组颈椎曲度优于CADR组,差异有统计学意义(P0.05);而3组VAS评分、NDI指数和SF-12评分比较差异无统计学意义(P0.05)。术后60个月时,ACDF组与CADR组VAS评分、NDI指数低于ACCF组,而SF-12评分高于ACCF组;ACDF组颈椎曲度优于ACCF组与CADR组,且CADR组优于ACCF组,差异有统计学意义(P0.05);而3组JOA评分差异无统计学意义(P0.05)。结论 ACCF在短期内神经功能恢复优于ACDF和CADR,但在随访中期ACCF在症状缓解、生活质量改善及颈椎曲度的维持方面却差于ACDF和CADR。     

椎体原位骨屑植骨技术在颈前路椎间盘切除减压融合内固定术中的应用

目的 分析椎体原位骨屑植骨技术在颈前路椎间盘切除减压融合内固定术(Anterior cervical discectomy and fu-sion,ACDF)中的应用效果.方法 回顾性分析自2015-01-2018-12采用ACDF治疗的184例退行性颈椎病,104例采用椎体原位骨屑植骨技术进行椎间融合(原位骨屑组),...