多节段脊髓型颈椎病两种减压融合术的比较△

Comparison of two anterior cervical decompression and fusion procedures for multi-segment cervical spondylotic myelopa⁃ thy

摘要:

［目的］ 比较前路颈椎体切除融合术 （anterior cervical corpectomy and fusion, ACCF） 联合前路颈椎间盘切除融合 （anterior cervical discectomy and fusion, ACDF） 与多节段单纯 ACDF 治疗多节段脊髓型颈病 （cervical spondylotic myelopathy, CSM） 的临床效果。［方法］ 回顾性分析 2015 年 8 月—2019 年 8 月前路减压融合治疗 CSM 86 例患者的临床资料。依据术前影像病变程度，21 例采用联合术式 （单节段 ACCF+单节段 ACDF），65 例采用多节段单纯 ACDF 术。比较两组围手术期、随访结果与影像资料。［结果］ 联合组术中显著失血量多于 ACDF 组 （P<0.05），但两组手术时间、早期并发症发生率、住院时间的差异均无统计学意义 （P>0.05）。术前联合组深反射评级、病理反射评级均显著重于 ACDF 组 （P<0.05），与术前相比， 术后两组患者深反射评级、病理反射评级、VAS 评分和 NDI 评分均显著改善（P<0.05）。术后联合组患者的深反射评级、病理反射评级均显著优于 ACDF 组 （P<0.05）。相应时间点，两组间 VAS、ODI 评分的差异均无统计学意义 （P>0.05）。影像方面， 与术前相比，末次随访时两组患者 CL、SCA、C2-7 SVA 均显著改善（P<0.05）。术前两组 CL、SVA 的差异均无统计学意义（P> 0.05），联合组 SCA 显著小于 ACDF 组（P<0.05），末次随访时，两组间 CL、SCA、SVA 的差异均无统计学意义（P>0.05）。［结论］ 对于部分长节段 ACDF 手术无法获得充分减压的多节段 CSM 患者，联合减压植骨融合术是一个安全而又有效的替代方法，可避免长节段 ACCF 的潜在并发症。

Abstract:

[Objective] To compare the clinical outcomes of anterior cervical corpectomy and fusion (ACCF) combined with anterior cervical discectomy and fusion (ACDF) versus multi- segment mere ACDF for multi- segment cervical spondylotic myelopathy (CSM) . [Methods] A retrospective study was conducted on 86 patients who underwent anterior decompression and fusion for multi-segment CSM in our hospital from August 2015 to August 2019. Of them, 21 patients received combined procedures (single- segment ACCF +ACDF), while the remaining 65 patients had multi-segment mere ACDFs performed. The perioperative, follow-up and imaging data were compared between the two groups. [Results] The combined group had significantly greater intraoperative blood loss than the ACDF group (P＜0.05) , but there was no significant difference in the operation time, the incidence of early complications, and hospital stay between the two groups (P＞0.05) . Before operation, the deep reflex scale and pathological reflex grade was much serious in the combined group than those in the ACDF group (P＜0.05) . Compared with pre-operatively, the deep reflex scale, pathological reflex grade, VAS score and NDI score improved significantly in both groups postoperatively (P＜0.05) . At corresponding time points, the deep reflex scale and pathological reflex grade be- came much better in the combined group than in the ACDF group (P＜0.05) , whereas no significant difference was noted in VAS and NDI scores between the two groups (P＞0.05) . With respect to imaging assessment, no differences in CL and SVA was found between two groups (P＞0.05) , but SCA was much less in the combined group than that in the ACDF group preoperatively (P＜0.05) , which all significantly im- proved at the last follow-up (P＜0.05) , and no significant difference was found between two groups (P＞0.05) . [Conclusion] For multi-seg- ment CSM, the single-segment ACCF combined with ACDF might provide sufficient decompression which multi-segment mere ACDF can-not provide, is a safe and effective alternative to the long-segment ACCF to avoid the potential complications of long-segment ACCF.