两种颈椎前路减压结构重建方式的比较研究

目的比较颈椎前路减压后前路一体化钢板椎间融合器结构重建和自体髂骨结构重建两种手术方法稳定性、融合率和疗效。方法56例行颈前路减压融合术的病例，按手术方式分为2组，其中颈椎前路减压自体髂骨植骨融合术组（A组）19例，颈椎前路椎间盘切除减压前路一体化钢板椎间融合器融合术组（B组）37例。术前、术后不同时期进行JOA评分，以判定临床疗效，同时测量D值（颈椎整体曲度）、融合节段前高（heightofanteriorbody，HAB）、融合节段后高（heightofposteriorbody，HPB）以及Cobb角（颈椎活动度）。依据融合标准判定并计算术后各时期减压节段融合率。采用配对t检验比较两组间每-参数术后各时期值与术前值的差值。结果术后3个月，A、B组减压节段融合率分别为89．5％（17／19）、83．8％（31／37），术后6个月全部随访病例达到骨性融合。与A组比较，B组融合节段后高差值（术后1周-术前）差异无统计学意义，其他各时期差异有统计学意义；两组活动Cobb角差值（术后24个月-术前）差异有统计学意义，而此前各个时期活动Cobb角差值差异无统计学意义；两组术后不同时期JOA改善率、D值差值、融合节段前高差值的差异均无统计学意义。结论颈椎前路减压-体化钢板椎间融合器融合术取得良好的疗效，在维持融合节段后高及改善颈椎活动度方面更具优势。

Comparison of two different approaches in cervical anterior decompression and structural reconstruction

Objective To compare cervical anterior plate cage benezech and autologous iliac crest graft after anterior cervical discectomy for fusion. Methods Fifty-six patients with degenerative cervical myelopathy who had surgical treatment were included in the study, including 19 cases with autologous iliac crest graft fusion （Group A） and 37 cases with cervical anterior plate cage benezech （PVB） fusion （Group B ） after anterior cervical discectomy for fusion. The curative effect was evaluated by the JOA scoring systems. Pre- and postoperative terms was measured on X-ray images, including the height of anterior body （ HAB）, the height of posterior body （ HPB）, Cobb angle, and D numerical value. The cervical segmental fusion status during postoperative follow-up period was evaluated. The paired t test was used for data analysis. Results The fusion rates of group A andgroup B were 89.5% （17/19） and 83.8% （31/37） at 3 months after operation, respectively; all cases in both groups achieved bony fusion 6 months after operation. There were significant differences in HPB of fusion segments between two groups, in all period of follow-up except before and first week after operation. There were significant differences in Cobb angle between two groups before and 24 months after operation, and there were no differences in the other period. There were no significant differences in JOA, D value and HAB between group A and group B. Conclusion Anterior cervical discectomy and fusion with PCB achieve good curative effect, which is better in maintaining fusion segment intervertebral height and improving the ROM of cervical spine.