ACCF联合颈前路减压zero-p椎间植骨融合内固定术治疗多节段脊髓型颈椎病

目的探讨颈前路椎体次全切除减压融合术(ACCF)联合颈前路减压zero-p椎间植骨融合内固定术治疗多节段脊髓型颈椎病的临床疗效。方法回顾性分析自2016-05—2017-07采用ACCF联合颈前路减压zero-p椎间植骨融合内固定术治疗的30例多节段脊髓型颈椎病,比较术前、术后1周及末次随访时JOA评分、颈椎Cobb角、椎间隙高度。结果30例均顺利完成手术并获得完整随访,随访时间平均21.6个月,切口均一期愈合,植骨均骨性愈合,无内固定松动、移位、断裂、伤口感染、声音嘶哑及神经功能加重等并发症。术后1例出现脑脊液漏,2例出现吞咽不适,非手术治疗后均治愈。术后1周与末次随访时JOA评分、颈椎Cobb角、椎间隙高度较术前均明显改善,差异有统计学意义(P<0.05)。末次随访时根据JOA评分改善率评定综合疗效:优12例,良14例,可4例。结论ACCF联合颈前路减压zerop椎间植骨融合内固定术治疗多节段脊髓型颈椎病安全可靠,能够有效地恢复椎间隙高度和颈椎生理曲度。

Anterior cervical corpectomy decompression and fusion combined with anterior cervical decompression and zero-p interboby fusion for multilevel cervical spondylotic myelopathy

Objective To evaluate the clinical results of anterior cervical corpectomy decompression and fusion(ACCF)combined with anterior cervical decompression and zero-p interboby fusion in treatment of multilevel cervical spondylotic myelopathy.Methods From May 2016 to July 2017,30 consecutive patients with multilevel cervical spondylotic myelopathy underwent ACCF combined with anterior cervical decompression and zero-p interboby fusion.The JOA score,Cobb angle and intervertebral space height were compared before and 1 week after operation,and at last follow-up.Results All the 30 cases successfully completed operation and obtained complete follow-up.The mean follow-up period was 21.6 months.The incisions healed on time,and bone graft got solid fusion in all cases.There were no internal fixation loosening,displacement and fracture,wound infection,hoarseness and aggravation of neurological function.Postoperative complications included cerebrospinal fluid leakage in 1 case and dysphagia in 2 cases,which were cured after conservative treatment.The JOA score,Cobb angle and intervertebral space height 1 week after operation and at the last follow-up were significantly improved when compared with preoperative ones(P<0.05).At last follow-up,the comprehensive efficacy was evaluated by JOA score.Twelve patients got an excellent outcome,14 patients good and 4 patients fair.Conclusion ACCF combined with anterior cervical decompression and zero-p interboby fusion can be used safely and feasibly for multilevel cervical spondylotic myelopathy.It can effectively restore intervertebral space height and cervical lordosis.