多节段脊髓型颈椎病两种减压融合术的比较
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叶福标,博士,副主任医师,研究方向:脊柱外科,(电话)15880899236,(电子信箱)yfb283@163.com

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R681.55

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福建省自然科学基金面上项目(编号:2021J01394);福建省卫计委中青年骨干人才培养项目(编号:2017-ZQN-8);福建省立医院“创双高 ”火石基金项目(编号:2019HSJJ02)


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

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叶福标,尹晓明,林飞跃,等. 多节段脊髓型颈椎病两种减压融合术的比较[J]. 中国矫形外科杂志, 2022, 30 (7): 608-613. DOI:10.3977/j. issn.1005-8478.2022.07.07.
YE Fu-biao, YIN Xiao-ming, LIN Fei-yue, et al. Comparison of two anterior cervical decompression and fusion procedures for multi-segment cervical spondylotic myelopa⁃ thy[J]. ORTHOPEDIC JOURNAL OF CHINA , 2022, 30 (7): 608-613. DOI:10.3977/j. issn.1005-8478.2022.07.07.

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  • 收稿日期:2020-08-20
  • 最后修改日期:2020-09-29
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  • 在线发布日期: 2023-06-10
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