A comparative study of anterior cervical discectomy and fusion versus anterior cervical corpectomy and fusion in the treatment of degenerative cervical myelopathy
-
摘要: 目的 比较颈椎前路椎间盘切除融合术(anterior cervical discectomy and fusion,ACDF)与颈椎前路椎体次全切除融合术(anterior cervical corpectomy and fusion,ACCF)治疗累及连续2个节段的退行性颈椎病(degenerative cervical myelopathy,DCM)的临床疗效。方法 选取40例累及连续2个节段的DCM患者纳入本次回顾性研究,根据所接受手术类型将患者分为2组,即ACDF组和ACCF组。ACDF组使用聚醚醚酮(poly ether-ether-ketone,PEEK)作为椎间融合器,ACCF组使用钛网(titanium mesh cage,TMC)作为椎间融合器。比较分析2组患者围手术期指标(平均住院时间、失血量、手术时间和并发症)、临床结果指标[日本骨科协会评分(JOA)、颈部与上肢疼痛视觉模拟(VAS)评分)和融合状态]。 结果 相比于ACDF组,ACCF组患者平均手术时间明显缩短(P<0.05),术中失血量明显增加(P<0.05),2组患者住院时间差异无统计学意义(P>0.05)。2组患者随访过程中JOA评分和颈部与上肢VAS评分较术前均明显好转(P<0.05),但2组之间比较差异无统计学意义(P>0.05)。结论 2种手术方法治疗连续2个节段的DCM均取得满意效果,然而ACCF较ACDF更容易发生钛网融合器下沉,因此建议选择ACDF术式。
-
关键词:
- 颈椎前路椎体次全切除融合术 /
- 颈椎前路椎间盘切除融合术 /
- 钛网 /
- 聚醚醚酮
Abstract: Objective To compare the clinical effectiveness of anterior cervical discectomy and fusion (ACDF) with anterior cervical corpectomy and fusion (ACCF) for the treatment of two-adjacent-level degenerative cervical myelopathy (DCM). Methods A total of 40 patients with two-adjacent-level DCM were enrolled in the current retrospective study. According to the type of surgery, the patients were divided into two groups: an ACDF group and an ACCF group. In the ACDF group, poly ether-ether-ketone (PEEK) was used as the intervertebral cage, whereas titanium mesh cage (TMC) was selected in the ACCF group. Both groups were compared for perioperative parameters including the length of hospitalization stay, blood loss, operation time, and complications), clinical outcomes including Japanese Orthopaedic Association (JOA) scores and visual analogue scale (VAS) scores for neck and arm pain, and fusion status. Results Compared with the ACDF group, the ACCF group presented remarkably decreased average operation timer (P<0.05), and increased blood loss during operation (P<0.05). There was no difference in the length of hospitalization stay between the two groups (P>0.05). During the follow-up period, JOA score and VAS score of neck and upper limb were significantly improved in both groups compared with preoperative values (P<0.05), but there was no difference between the two groups (P>0.05). Conclusions Both surgical?options can achieve satisfactory results in the treatment of two-adjacent-level DCM. However, ACDF is suggested with respect to the possible subsidence of titanium mesh cage during ACCF. -
-
[1] 陈光福,赵晓东,王敏,等.颈前路经椎间盘显微手术减压治疗神经根型颈椎病[J].中华显微外科杂志,2018,41(6):593-595. [2] 关海山,李承罡,史洁,等.前路减压融合术与后路单开门椎管扩大成形术治疗多节段脊髓型颈椎病的中期随访研究[J].中华骨科杂志,2019,39(17):1044-1052. [3] 李会明,夏刚,田融.两种颈前路减压重建术治疗多节段脊髓型颈椎病的疗效比较[J].中华实验外科杂志,2016,33(5):1409-1411. [4] 刘宁,陈勤,钟红发,等.超声骨刀在颈椎前路椎体次全切除手术中的运用[J].实用医学杂志,2017,33(18):3081-3084. [5] 王欣,方红育,范明宇,等.两种不同颈前路减压植骨融合内固定术治疗颈椎病的疗效比较[J].颈腰痛杂志,2018,39(4):504-505. [6] Gercek E,Arlet V,Delisle J,et al.Subsidence of stand-alone cervical cages in anterior interbody fusion:warning[J].Eur Spine J,2003,12(5):513-516.
[7] Liu Y,Qi M,Chen H,et al.Comparative analysis of complications of different reconstructive techniques following anterior decompression for multilevel cervicalspondylotic myelopathy[J].Eur Spine J,2012,21(12):2428-2435.
[8] 时述山,季新民,胥少汀,等.颈椎前路减压植骨融合术的并发症分析[J].中国脊柱脊髓杂志,1995,5(1):5-7. [9] Oh MC,Zhang HY,Park JY,et al.Two-level anterior cervical discectomy versus one-levelcorpectomy in cervical spondylotic myelopathy[J].Spine,2009,34(7):692-696.
[10] Uribe JS,Sangala JR,Duckworth EA,et al.Comparison between anterior cervical discectomy fusion and cervical corpectomy fusion using titanium cages for reconstruction:analysis of outcome and long-term follow-up[J].Eur Spine J,2009,18(5):654-662.
[11] Park Y,Maeda T,Cho W,et al.Comparison of anterior cervical fusion after two-level discectomy or single-levelcorpectomy:sagittal alignment,cervical lordosis,graft collapse,and adjacent-level ossification[J].Spine J,2010,10(3):193-199.
[12] Daubs MD.Early failures following cervicalcorpectomy reconstruction with titanium mesh cages and anterior plating[J].Spine (Phila Pa 1976),2005,30(12):1402-1406.
-
期刊类型引用(2)
1. 吴迪，季雨晴，秦绪沛. 术前常规MRI+颈椎矢状面参数预测神经根型颈椎病术后病情转归价值及对手术治疗指导意义分析. 中国CT和MRI杂志. 2024(01): 49-52 . 
百度学术
2. 徐东阳，吴杰，管礼安，薛书生. ACDF与ACCF治疗双节段颈椎病的效果对比分析. 中国医学创新. 2024(28): 153-157 . 百度学术
其他类型引用(3)
计量
- 文章访问数: 583
- HTML全文浏览量: 1
- PDF下载量: 386
- 被引次数: 5
下载:
.png)
