前路颈椎椎间盘切除融合术与动态装置植入术治疗单节段颈椎椎间盘突出症

目的对比前路颈椎椎间盘切除融合术(ACDF)与颈椎前路动态装置植入术(DCI)对单节段颈椎椎间盘突出症(CDH)患者颈椎活动度(ROM)及术后颈椎曲度的影响。方法回顾性分析2018年6月—2019年9月海军军医大学长征医院收治的78例单节段CDH患者临床资料,其中42例采用ACDF治疗(ACDF组),36例采用DCI治疗(DCI组)。记录并比较2组患者手术时间、术中出血量,术前及术后1年日本骨科学会(JOA)评分、疼痛视觉模拟量表(VAS)评分、手术节段Cobb角、C2~7颈椎曲度、邻近椎体高度及颈椎各运动方向(前屈后伸、左右侧曲、左右旋转)的ROM。结果所有手术顺利完成。2组术中出血量比较,差异无统计学意义(P>0.05)。DCI组手术时间比ACDF组短,差异有统计学意义(P<0.05)。2组患者术后1年JOA评分、VAS评分和邻近椎体高度均较术前改善,差异有统计学意义(P<0.05);组间比较,差异无统计学意义(P>0.05)。术后1年ACDF组C2~7颈椎曲度、手术节段Cobb角均较术前有所丢失,DCI组无明显丢失,组间比较,差异有统计学意义(P<0.05)。术后1年2组前屈后伸、左右侧曲ROM与术前比较均未出现明显变化,差异无统计学意义(P>0.05)。术后1年2组左右旋转ROM出现了相近程度的受限,与术前比较,差异有统计学意义(P<0.05);组间比较,差异无统计学意义(P>0.05)。结论ACDF与DCI治疗单节段CDH均可获得满意的临床效果,虽然ACDF术后影像学资料显示有生理曲度的丢失,但颈椎ROM维持良好,并不影响患者的生活质量。

Anterior cervical discectomy and fusion and dynamic cervical implantation for single-segment cervical disc herniation

Objective To compare the effects of anterior cervical discectomy and fusion(ACDF) and dynamic cervical implantation(DCI) in the treatment of single-segment cervical disc herniation(CDH) on cervical range of motion(ROM) and postoperative cervical curvature. Methods The clinical data of 78 patients with single-segment CDH admitted to Changzheng Hospital Affiliated to Navy Medical University from June 2018 to September 2019 were retrospectively analyzed,of whom 42 were treated with ACDF(ACDF group) and 36 with DCI(DCI group). The operation time,intraoperative blood loss,and Japanese Orthopaedic Association(JOA) score,visual analogue scale(VAS) score,Cobb''s angle,C_2-7 cervical curvature,adjacent vertebral height,ROM of flexion and extension,left and right lateral flexion,left and right rotation at pre-operation and postoperative 1 year were recorded and compared between the 2 groups. Results All the operations were completed successfully. There was no significant difference in intraoperative blood loss between the 2 groups(P>0.05). The operation time of DCI group was shorter than that of ACDF group,with a statistical significance(P<0.05). The JOA score,VAS score and adjacent vertebral height of the 2 groups at postoperative 1 year were significantly improved compared with those before operation,and the differences were statistically significant(P<0.05),but there was no significant difference between the 2 groups(P>0.05). In ACDF group,C_2-7 cervical curvature and Cobb''s angle were lost at postoperative 1 year,but not in DCI group,and the differences were statistically significant between the 2 groups(P<0.05). ROM of flexion and extension,left and right lateral flexion did not change in both groups at postoperative 1 year compared with those before operation,and the differences were not statistically significant(P>0.05). ROM of left and right rotation was limited to a similar degree,with significant difference compared with that before operation(P<0.05);but there was no significant difference between the 2 groups(P>0.05). Conclusion ACDF and DCI can achieve satisfactory clinical results in the treatment of single-segment CDH. Although the imaging data after ACDF show the loss of physiological curvature,it shows that the cervical ROM maintains well,and does not affect the patient''s quality of life.