Hybrid术式治疗多节段颈椎病的短中期临床疗效研究

目的 评估颈椎Hybrid手术治疗多节段颈椎病的短中期临床疗效.方法 收集2012年6月至2014年4月武警总医院脊柱外科应用Hybrid手术治疗多节段颈椎病患者49例,其中男26例,女23例,平均年龄53.4(43～62)岁.49例患者中神经根型颈椎病5例、脊髓型颈椎病10例、混合型颈椎病34例;双节段10例、三节段39例.通过颈部疼痛视觉模拟量表(VAS)评分和颈椎功能障碍指数(NDI)及日本骨科协会评估治疗分数(JOA)评估术后疗效,同时随访颈椎动力位X线片评估全颈椎节段手术前后的活动度(ROM).结果 术后随访24～46个月,平均(42.6±2.2)个月.术前、术后3个月和末次随访的颈痛VAS评分分别为(6.9±1.4)、(2.5±0.9)和(0.7±0.6)分(P<0.05);颈椎NDI分别为(24.6±8.6)、(17.8±6.1)和(13.8±4.2)分(P<0.05);颈痛JOA分别为 (11.9±2.8)、(12.6±1.5)和(14.8±1.4)分(P<0.05);颈椎ROM分别为 (44.2±8.1)、(34.1±6.8)和(30.4±9.5)°(P<0.05).结论 Hybrid术式治疗多节段颈椎病的临床疗效满意,能保留置入节段一定的活动度,可作为多节段颈椎病治疗方法之一.

Short-and medium-term clinical outcomes of Hybrid surgery for treatment of multi-level cervical spondylosis

Objective To evaluate the clinical efficacy of Hybrid surgery for treatment of multi-level cervical spondylosis.Methods A total of 49 patients (26 males, 23 females) with cervical spondylosis treated with Hybrid surgery between June 2012 and April 2014 were retrospectively reviewed.There were 5 cases with cervical spondylitis radiculopathy (n=5), 10 cases with cervical spondylitis myelopathy (n=10) and 34 cases with mixed cervical spondylitis (n=34).Among the 49 patients, 10 underwent two-segment surgery (n=10) and 39 underwent three-segment surgery (n=39).The mean age of patients was 53.4 years (range from 43 to 62 years).Visual analogue scale (VAS), neck disability index (NDI) and Japanese Orthopedics Association Scores (JOA) were used to evaluate the clinical outcomes.Cervical radiography was used to observe the range of motions (ROM) in C2-C7 segments.Results Mean follow-up time was(42.6±2.2)months (ranging from 24 to 46 months).The mean VAS score for neck pain was significantly decreased from (6.9±1.4) preoperatively to (2.5±0.9) at 3 months postoperatively, and (0.7±0.6)during the last follow-up, respectively(P<0.05).The mean NDI score was significantly reduced from (24.6±8.6) preoperatively to (17.8±6.1) at 3 months postoperatively, and(13.8±4.2) during the last follow-up, respectively(P<0.05).The mean JOA scores increased from (11.9±2.8) preoperatively to(12.6±1.5)at 3 months postoperatively, and (14.8±1.4) during the last follow-up (P<0.05).The ROM of C2-C7 segment reduced from (44.2±8.1)°preoperatively to(34.1±6.8)°at 3 months postoperatively, and(30.4±9.5)°during the last follow-up(P<0.05).Conclusion The clinical outcomes of Hybrid surgery are excellent in the treatment of multilevel cervical spondylosis.The motion of the non-fusion segments is reserved and the decompression is complete.It could be an alternative treatment for multilevel spondylosis.