Hybrid手术对多节段颈椎退行性病变椎体的生物力学影响

目的 探讨Hybrid手术对多节段颈椎退行性病变椎体的生物力学的影响。 方法 自2014年1月-2016年12月,前瞻性收集温州市中西医结合医院收治的多节段颈椎退行性病变的患者78例,将患者随机分为观察组和对照组,各39例。观察组采用Hybrid手术治疗,对照组采用颈椎前路融合手术治疗。观察2组患者手术时间、术中出血量、术后引流量、住院时间、颈椎功能障碍指数(NDI)评分、日本骨科协会(JOA)评分、疼痛视觉模拟评分法(VAS)评分、Odom临床满意分级、C_2~7整体活动度、Cobb's角、手术节段上一节段活动度(SROM)、手术节段的下一节段活动度(IROM)、并发症。 结果 2组患者术前、术后6个月时NDI、ODI评分和C_2~7颈椎整体活动度差异均无统计学意义(P>0.05)。但与对照组比较,观察组患者术后12个月时NDI评分降低,而ODI评分和C_2~7颈椎整体活动度增高(P<0.05)。术后12个月时,观察组优良率显著高于对照组(P=0.017)。2组患者术前VAS评分差异无统计学意义(P=0.244)。与对照组比较,观察组术后6个月和12个月时VAS评分均显著降低(P<0.05)。2组患者手术时间、术中出血量、术后引流量、住院时间、术前术后Cobb's角、SROM、IROM和术后并发症等差异均无统计学意义(均P>0.05)。 结论 Hybrid手术可改善多节段颈椎退行性病变患者术后颈椎活动度,临床疗效满意。 

Biomechanical effects of Hybrid surgery on vertebral body in multilevel cervical degenerative disc disease

Objective To investigate the biomechanical effect of hybrid surgery on vertebral body in multilevel cervical degenerative disc disease. Methods A total of 78 patients with multilevel cervical spine degenerative disease from January, 2014 to December, 2016 in our hospital were collected prospectively and were divided randomly into observation group and control group with 39 cases in each group. The patients in the observation group underwent Hybrid surgery treatment, while the patients in the control group underwent cervical fusion surgery treatment. The operation time, intraoperative blood loss, postoperative drainage, hospital stay, Neck Disability Index (NDI), Japanese Orthopedic Association (JOA), Visual analog scale (VAS), Odom clinical satisfaction scale, C_2-7 overall mobility, Cobb angle, Superior adjacent segment ROM (SROM), inferior adjacent segment ROM (IROM) and complications in the two group were observed. Results There was no statistical difference between NDI, ODI score and C_2-7 cervical overall mobility (P>0.05). Compared with the control group, NDI score of the observation group by the end of 12 months after the operation was decreased, while the ODI score and C_2-7 cervical overall mobility was increased significantly (P<0.05). Twelve months after the operation, the excellent rate of the observation group was higher than that in the control group (P=0.017). There was no statistical significance between the VAS scores in the two group (P=0.244). Compared with the control group, VAS scores of the observation group by the end of 6 month and 12 months after the operation decreased significantly (P<0.05). There was no statistical significance in the operation time, intraoperative blood loss, postoperative drainage, hospital stay, Cobb angle before and after operation, SROM, IROM and complications between the two groups (P>0.05). Conclusion Hybrid surgery can improve the postoperative cervical mobility of the patients with multilevel cervical spine degenerative disease. The clinical effectiveness was satisfactory.