颈椎间盘置换和ACDF治疗颈椎病的临床疗效比较

目的 比较颈椎间盘置换和颈前路椎间盘切除减压植骨融合术(ACDF)治疗颈椎病的临床疗效.方法 选择2011年7月至2013年1月期间我院收治的76例经诊断为脊髓型颈椎病的患者,依据随机数字表法将患者分为观察组和对照组各38例,对照组应用ACDF治疗,观察组应用人工颈椎间盘置换术治疗,比较两组患者的临床治疗效果.结果 两组在手术时间(93.31 ± 20.14) min vs (94.02 ± 21.52) min]、出血量(101.62 ± 23.41) ml vs (102.94±24.05) ml]、住院时间(6.25±0.73) d vs (6.37±0.75) d]及Odom分级评定(总有效率均为100%)等方面比较差异无统计学意义(t=3.15、2.27、1.59,χ2=1.38,P>0.05);观察组术后病变颈椎(46.57±6.67) vs (37.58±7.16)]及邻近颈椎的ROM显著优于对照组,组间比较差异有统计学意义(t=7.31,P<0.05);两组治疗后JOA评分显著改善,较治疗前比较差异有统计学意义观察组:(16.07±4.32) vs (9.56±2.71),t=6.94,P<0.05;对照组:(16.14±4.46) vs (9.61±2.75,t=5.83,P<0.05].结论 与ACDF术式相比,人工颈椎置换术式在治疗颈椎病方面不仅可保持较为稳定的颈椎ROM,而且还可有效避免邻近节段颈椎过早发生退行性变,临床效果满意,值得应用.

Comparative analysis of the clinical efficacy of cervical disc replacement and ACDF in treatment of cervical spondylosis

Objective To compare the clinical effect of cervical disc replacement and anterior cervical decom-pression and fusion (ACDF) in the treatment of cervical spondylosis. Methods Seventy-six patients with cervical spon-dylosis were divided into observation group and control group, with 38 patients in each group. The control group was treated with ACDF, and the observation group was treated with artificial cervical disc replacement. The clinical effect of two groups was compared between the two groups. Results There was no significant difference in operation time (93.31±20.14) min vs (94.02±21.52) min], blood loss (101.62±23.41) ml vs (102.94±24.05) ml], length of hospital stay (6.25±0.73) d vs (6.37±0.75) d], and Odom grade (100%vs 100%) between the two groups (t=3.15, 2.27, 1.59,χ2=1.38, P>0.05). The ROM of pathological changes of cervical vertebra (46.57 ± 6.67) vs (37.58 ± 7.16)] and adjacent cervical vertebra was significantly higher in the observation group than that in the control group (t=7.31, P<0.05). The JOA scores of the two groups after treatment showed statistically significant difference with those before treatment the obser-vation group:(16.07±4.32) vs (9.56±2.71), t=6.94, P<0.05;the control group:(16.14±4.46) vs (9.61±2.75), t=5.83, P<0.05]. Conclusion When compared with ACDF, artificial cervical disc replacement can not only maintain a relatively stable cervical ROM, but also effectively avoid the premature degeneration of adjacent segment of cervical vertebra.