人工颈椎间盘置换与颈前路减压植骨融合治疗脊髓型颈椎病的中期临床观察

目的比较Bryan人工颈椎间盘置换术与经颈前路减压融合术治疗脊髓型颈椎病的临床疗效。方法回顾性分析2005年1月～2009年1月收治的57例颈椎病手术的病例，其中19例行人工颈椎盘置换术（置换组），38例行颈前路减压融合术（融合组）。结果置换组术后颈部生理活动度得到保持，JOA评分由9．6±3．5升至14．3±4．6（2年）、16．1±3．2（5年），dom评定满意率100％；融合组术后颈部活动度由（48．6±6．1）°降至（36．6±3．5）°（单节段融合）和48．4°±4．1°降至27．3±5．3°（双节段融合），Odom评定满意率97．3％。结论人工颈椎间盘置换术与颈前路减压融合术治疗脊髓型颈椎病中期疗效满意，前者不加速相邻节段的退变，显著减少由融合导致的多种并发症。

Mid -term Clinical Observation for Treatment of Cervical Myelopathy with Fusion of Artificial Cervical Disc Replacement and Anterior Cervical Decompression

Objective To verify the clinical outcome of artifieal cervical disc replacement versus anterior decompression and fusion in the treatment of cervical spondylotlcmyelopathy. Methods A total of 57 cases of cervical spondylotic myelopathy treated by surgical operation between January 2005 and March 2009 were reviewed. 19 cases were treated with artifieal cervical disc replacement and 38 were treated with anteriorial decompression and fusion. Results The cervical vertebral physiological activity was preserved in artifical cervical disc replacement groups. The JOA score increased from 9.6 ：l： 3.5 to l 4.3 ＋ 4.6 at 2 years, to 16.1 ± 3.2 at 5 - year follow - up, and 100% （ 19/19 ） cases had satisfactory results according to the Odom evaluation. In anterior decompression and fusion groups, the cervical vertebral physiological activity degree decreased from an average of 48.6°± 6.1 °to 36.6°±3.5°in single - level fu- sion patients and 48.4°±4. 1°to 27.3±5.3°in two - level fusion,with the satisfactory resuhof 97.3% according to the Odom evaluation. Conclusion The mid - term outcomes of artifical cervical disc replacement versus anterior cervical decompression and fusion for the treatmentof cervical spondylotic myelopathy were satisfactory. The former not only avoided accelerating the degeneration of adjacent segments, but also significantly reduced complications resulting from the fusion of cervical vertebra.