颈前路非融合与融合技术联合应用治疗颈椎病

目的:评价颈前路融合与非融合技术联合应用治疗颈椎病的临床疗效。方法 :2008年3月～2010年6月期间,采用前路减压融合(anterior cervical discectomy and fusion,ACDF)术联合颈人工椎间盘置换术(cervi-cal artificial disc replacement,C-ADR)治疗28例颈椎病患者,手术涉及二个椎间隙19例,涉及三个椎间隙9例,置换和融合为相邻间隙24例,非相邻间隙4例。术前、术后进行JOA评分和颈椎残障功能量表(neck dis-ability index,NDI)评定,按Odom标准评定治疗效果。根据术前、术后、随访时的颈椎标准侧位X线片,观察植骨融合、内固定及人工椎间盘的情况。结果:手术均顺利完成,手术时间70～150min,平均85min;出血量50～300ml,平均180ml。1例患者术后出现轻度呼吸困难,对症处理后症状逐步好转。术后切口均Ⅰ期愈合,无椎动脉损伤及喉返神经损伤发生。经过14～39个月(平均22个月)随访,所有患者内置入物无松动、移位,植骨融合时间在3～8个月,平均4.5个月;所有人工椎间盘置换节段运动功能良好。术前JOA评分为10.3分,末次随访时为13.8分,平均改善率为52.2%;术前NDI评分为38.5分,末次随访时为22.3分,较术前显明改善(P<0.01)。末次随访时按Odom标准评定手术疗效:优14例,良8例,尚可5例,差1例。结论:颈前路融合与非融合技术联合应用可综合两种技术的优点,在彻底减压的同时,减可少固定融合节段。

Anterior combination of non-fusion and fusion approach for cervical spondylosis

Objectives: To observe the clinical outcome of anterior combination of non-fusion and fusion approach for cervical spondylosis.Methods: Twenty-eight cases with cervical spondylosis(CS) undergoing combination of anterior cervical discectomy and fusion(ACDF) and cervical artificial disc replacement(C-ADR) between March 2008 and June 2010 were reviewed.Two levels of intervertebral discs were involved in 19 cases,while three levels were involved in 9 cases.The levels of fusion and non-fusion were adjacent in 24 cases while not adjacent in 4 cases.Preoperative and follow-up JOA scores and neck disability index(NDI) were utilized.Clinical results were evaluated according to the Odom standard.Preoperative,immediate postoperative and follow-up X-rays were used to evaluate the bony fusion and instrumentation.Results: All the operations were completed successfully.The operation time was 85min in average(from 70 to 150min),and the amount of bleeding was 180ml in average(from 50 to 300ml).1 case who had a slight dyspnea was improved gradually after symptomatic treatment.The wounds were all healed at stage Ⅰ.There was no damage of vertebral artery or recurrent laryngeal nerve.All of the 28 cases were followed up for 14-39 months(average,22 months).No autograft or instrument failure was found.Time for bony fusion was 3-8 months(average,4.5 months).All the cervical artificial discs had good motor function.Preoperative JOA score was 10.3,which significantly increased to 13.8 at final follow-up.Preoperative NDI score was 38.5,which significantly decreased to 22.3 at final follow-up(P<0.01).Odom standard at final follow-up showed 14 excellent,8 good,5 fair and 1 poor.Conclusions: Anterior combination of non-fusion and fusion approach is reliable for decompression as well as shortening fusion segments.