两种前路减压融合术治疗颈椎间盘突出症的比较

目的对前路颈椎间盘切除减压的碳纤维椎间融合器(cage)植入术与自体髂骨块植骨加钛板固定术治疗单节段颈椎间盘突出症(CDH)进行临床疗效及影像学评估。方法需要手术治疗的单节段CDH患者60例,其中前路减压cage植入术31例,自体髂骨块植骨加钛板固定术29例。术前、术后及随访期间摄X线片,比较两组病例的手术时间、术中出血量、术后并发症、症状改善率、融合时间、融合率、融合节段椎体间高度的维持情况。结果cage植入术较自体髂骨块植骨加钛板固定术手术时间短,出血少(P<0.01)。两组融合节段椎体间高度较术前均明显改善(P<0.01)。两组间症状改善率、融合率无统计学意义(P>0.05)。cage植入术较自体髂骨块植骨加钛板固定术并发症少。结论cage植入术和自体髂骨块植骨加钛板固定术都是前路减压治疗单节段CDH的重要而有效的方法。而cage植入术在减小手术创伤的同时,可以获得同样的临床效果,是治疗单节段CDH理想的术式之一。

A comparative study of two different types of anterior cervical discectomy and interbody fusion for single level cervical disc herniation

Objective To compare the effects of anterior cervical discectomy and interbody fusion with carbon fibre cage or autogenous iliac crest graft combined with titanium plate fixation for the treatment of single level cervical disc herniation(CDH).Methods 60 patients were treated and followed up.These patients were treated with different methods including:anterior cervical discectomy and interbody fusion with carbon fibre cage in 31 cases;anterior cervical discectomy and interbody fusion with autogenous iliac crest graft combined with titanium plate fixation in 29 cases.Operation time,hemorrhage amount,postoperative complication,the symptom recovery rate,the graft fusion rate and time,the maintainence of the height of intervertebral space were compared between two groups.Results Operation time was shorter and hemorrhage amount was less in fusion with cage than those in fusion with autogenous iliac crest graft combined with titanium plate fixation(P<0.01).Both of two kinds of operation had a satisfactory effect on the the height of intervertebral space(P<0.01).There was no difference in the symptom recovery rate and the graft fusion rate between two groups(P>0.05).Conclusion The anterior cervical discectomy and interbody fusion with cage and with autogenous iliac crest graft combined with titanium plate fixation are important and effective in treatment of single level CDH.The interbody fusion with cage produce the same surgical results,while it does decrease the trauma of operation.