人工颈椎间盘置换术与颈椎前路减压植骨融合术治疗颈椎病的效果比较

目的 采用人工颈椎间盘置换术（ACDR）与颈椎前路减压植骨融合钛板内固定术（ACDF）治疗单节段颈椎病,观察近期临床疗效及随访结果比较.方法 收集2004年1月～2012年1月本院采用两种手术方法治疗的单节段颈椎病患者20例,记录所采用的不同术式的疗效以及术后随访结果.术前及术后随访采用JOA脊髓型颈椎病评分,颈椎功能障碍指数（NDI）,Odom评级判断疗效,视觉模拟评分法（visual analogue scale/score,简称VAS）记录上肢痛及颈肩痛,简明健康状况调查表SF-36量表判定手术后的临床疗效.结果 采用ACDR组9例,ACDF组11例.两组患者在末次随访均无并发症发生,术后临床症状得到明显缓解,随访JOA评分、SF-36量表评分、VAS评分较术前均明显提高,NDI评分下降,差异有统计学意义（P ＜ 0.05）.组间比较SF-36躯体评分和精神评分在末次随访时A组优于B组,而且差异有统计学意义（P ＜ 0.05）.术后疗效评估A组优于B组,而且差异有统计学意义（P ＜ 0.05）.结论 两种手术方式均达到了满意的手术效果,在临床疗效的评估及健康状况调查表中ACDR更有优势.

Comparison on efficacies of cervical spondylosis treated with artificial cervical disc replacement and anterior cervical decompression and fusion

Objective To observe the short-term clinical efficacies and compare the follow-up results through treatment of single-segment cervical spondylosis with artificial cervical disc replacement （ACDR） and anterior eervieal decompression and fusion （ACDF）. Methods Twenty cases of patients with ingle-segment cervical spondylosis treated with ACDR and ACDF in our hospital during Jan. 2004 to Jan. 2012 were collected for recording efficacies of different surgical approaches and follow-up results after operation. The JOA cervical spondylotic myelopathy scoring, the neck disability index （NDI） and Odom rating were used to determine efficacy before operation and follow-up after operation, and visual analogue scale/score （VAS） was used to record upper extremity pain, neck and shoulder pain, and the short form of health status survey （SF-36 scale） were used to determine the clinical efficacy after operation. Results Nine cases of patients were taken ACDR （A group）, and 11 cases of patients were taken ACDF （B group）. Two groups of pa- tients had no complications at the last fi~llow-up, their postoperative clinical symptoms were all markedly relieved, and their fi~llow-up JOA scores, SF-36 scale scores and VAS scores were significantly increased, and the ND! scores de- creased, the differences were statistically significant （P 〈 0.05）. The SF-36 physical scores and mental scores at the last fi~llow-up of group A wex~ higher than that of group B, and the difference was statistically significant （P 〈 0.05）. More- over, the evaluation of postoperative efficacy of group A was superior to that of group 13, and Ihe difference was statisti- cally significanl （P 〈 0.05）. Conclusion Both of the two operation approaches reached satisfied efficacies and the AC- DR show more advantages in the clinical efficacy evaluation and restdts of heahh status survey form.