两种颈前路手术方式治疗多节段脊髓型颈椎病的临床效果比较

目的比较两种颈前路手术方式治疗多节段脊髓型颈椎病(MCSM)的临床效果。方法选取我院2016年6月至2018年9月收治的31例MCSM患者,根据手术方式分为A组(14例)和B组(17例)。A组行多间隙颈前路椎间盘切除减压融合术(ACDF)+零切迹椎间融合器(Zero-P)治疗,B组行颈前路混合式减压融合术(ACHDF)治疗。比较两组患者的围手术期指标、随访及并发症发生情况、脊髓功能及影像学指标。结果 A组的手术时间短于B组,术中失血量少于B组(P<0.05)。两组患者均随访至少1年,平均(15.7±5.8)个月。两组并发症总发生率无显著差异(P>0.05)。术后1月和末次随访时,两组的JOA评分、颈椎Cobb角及颈椎前柱高度均较术前明显改善(P<0.05);但两组的JOA评分、颈椎Cobb角及颈椎前柱高度比较,差异无统计学意义(P>0.05)。结论两种颈前路手术方式治疗MCSM的早期效果相似,但多间隙ACDF+Zero-P的手术时间短、术中失血量少。

Comparison of clinical effects of two kinds of anterior cervical surgery in the treatment of multilevel cervical spondylotic myelopathy

Objective To compare the clinical effects of two kinds of anterior cervical surgery in the treatment of multilevel cervical spondylotic myelopathy(MCSM).Methods A total of 31 patients with MCSM admitted in our hospital from June 2016 to September 2018 were selected and divided into group A(14 cases)and group B(17 cases)according to the surgical methods.The group A underwent multi-space anterior cervical discectomy and fusion(ACDF)+zero-profile interbody fusion device(Zero-P)treatment,and the group B underwent anteriorcervical hybrid decompression and fusion(ACHDF)treatment.The perioperative indicators,follow-up and complications,spinal cord function and imaging indicators of the two groups were compared.Results The operation time of the group A was shorter than that of the group B,and the intraoperative blood loss was less than that of the group B(P<0.05).Both groups were followed up for at least one year,with an average of(15.7±5.8)months.There was no significant difference in the total incidence of complications between the two groups(P>0.05).At 1 month after operation and the last follow-up,the JOA score,cervical Cobb angle and cervical anterior column height of the two groups significantly improved compared with those before operation(P<0.05);but there were no significant differences in JOA score,Cobb angle and anterior column height between the two groups(P>0.05).Conclusion The early curative effects of the two anterior cervical surgery methods for the treatment of MCSM are similar,but the operation time of multi-space ACDF+Zero-P is short and the intraoperative blood loss is small.