脊髓性颈椎病显微镜辅助下前路减压整合术
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空军军医大学第二附属医院

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国家自然科学基金面上项目( 编号: 81372045);陕西省创新能力支撑计划项目(2021TD-45);空军军医大学第二附属医院临床研究重大项目(2021LCYG014)


Effect of microscope assisted anterior cervical decompression and fusion fixation in the treatment of cervical spondylotic myelopathy
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Air Force Military Medical University Tang-Du Hospital

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    摘要:

    摘要:[目的]比较显微镜下颈椎前路切开探查减压、髓核摘除、植骨融合内固定术(anterior cervical discectomy fusion,ACDF)较传统ACDF治疗脊髓型颈椎病的临床疗效;[方法]回顾性分析我院2015年6月-2018年11月治疗的65例脊髓型颈椎病患者的临床资料,根据医患术前沟通结果:传统组共35例,其中单节段21例,两节段14例;显微镜组共30例,其中单节段15例,双节段15例。比较两组围手术期、随访和影像资料;[结果]两组患者均顺利手术,显微组术中出血量和手术时间均显著少于传统组[(104.17±20.64)ml vs(129.77±47.96)ml,(93.53±13.16)min vs(101.37±15.89)min,P<0.05]。随时间推移,两组JOA评分显著增加(P<0.05),VAS评分显著降低(P<0.05),NDI评分显著减少(P<0.05)。术前两组患者间VAS、JOA和NDI评分的差异均无统计学意义(P>0.05),术后6个月、末次随访,显微组的JOA评分均显著优于传统组[(16.83±2.17)vs(15.74±1.60),(28.90±1.97)vs(27.34±1.67),P<0.05],术后6月、末次随访两组间VAS和NDI评分的差异已无统计学意义(P>0.05);影像方面,术后两组患者C2-7Cobb 角和病变椎间高度、责任椎管面积均较术前显著增加(P<0.05),相应时间点两组间C2-7Cobb 角和病变椎间高度、责任椎管面积的差异均无统计学意义(P>0.05)[结论]显微镜下ACDF较传统手术具有出血量少、手术时间短、疼痛程度减轻、神经功能改善显著、颈椎功能恢复良好的优点。

    Abstract:

    Abstract: [Objective] This study aimed to investigate the clinical efficacy and outcome of microscope-assisted anterior cervical discectomy and fusion (ACDF) with traditional ACDF of cervical spondylotic myelopathy.Methods: A retrospective was conducted on 65 patients who underwent surgical treatment for cervical spondylotic myelopathy in our hospital from June 2016 to November 2018. According to the consequences of preoperative doctor-patient communication, 30 patients received microscope cohort, while the remaining patients underwent non-microscope cohort. The perioperative, follow up and radiographic documents were compared between the two groups. The microscopy group had significantly less intraoperative blood loss and duration of surgery than the traditional group [(104.17±20.64) ml versus (129.77±47.96)ml,(93.53±13.16)min versus(101.37±15.89)min,P<0.05], The JOA scores increased significantly(P<0.05), while the NDI scores and VAS scores decreased significantly in both groups over time (P<0.05) .There were no significant differences in JOA and NDI、VAS scores between the two groups before operation (P>0.05). The microscopy group proved significantly superior to the traditional group regarding the JOA scores six month and follow up after operation [(16.83±2.17)versus(15.74±1.60),(28.90±1.97)versus(27.34±1.67),P<0.05]. regardless of that the differences became not statistically significant at 6 months and follow up after surgery between the two groups in NDI、VAS scores (P>0.05) [Results] Patients in both groups were successfully operated. In terms of imaging evaluation, the C2-7 Cobb angle, the height of the involved disc and spinal canal area of the responsible segment significantly improved in both groups at the latest follow-up compared with those preoperatively (P<0.05). At any corresponding time point, there was no statistically significant difference in the above-mentioned items measured radiographically between the two groups(P>0.05) [Conclusion] Compared with traditional surgery, ACDF under microscope has the advantages of less bleeding, shorter operation time, less pain, obvious improvement of neurological function, and good recovery of cervical function

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  • 收稿日期:2021-12-06
  • 最后修改日期:2022-04-19
  • 录用日期:2022-07-19
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