中华外科杂志
中華外科雜誌
중화외과잡지
CHINESE JOURNAL OF SURGERY
2012年
3期
238-242
,共5页
刘海鹰%许晓诺%王波%王会民%朱震奇%缪克难
劉海鷹%許曉諾%王波%王會民%硃震奇%繆剋難
류해응%허효낙%왕파%왕회민%주진기%무극난
颈椎病%颈椎%脊柱融合术%椎间盘%假体植入
頸椎病%頸椎%脊柱融閤術%椎間盤%假體植入
경추병%경추%척주융합술%추간반%가체식입
Cervical spondylosis%Cervical vertebrae%Spinal fusion%Intervertebral disc%Prosthesis implantation
目的 评估颈椎人工间盘置换结合颈椎椎间融合(Hybrid手术)治疗颈椎病的临床疗效及其对相邻颈椎节段的影响.方法 回顾性分析2007年12月至2010年6月共17例因颈椎病行双节段Hybrid手术患者(Hybrid组)的临床资料,选取同期行颈椎前路减压融合手术(ACDF)的17例患者作为对照(ACDF组).对两组患者术前、术后1、3、6个月的日本骨科协会评分(JOA)、颈椎功能障碍指数评分( NDI)、C2～7整体活动度、手术相邻颈椎节段活动度等结果进行对照评价.结果 Hybrid组和ACDF组患者术后JOA评分、NDI评分较术前均有改善(JOA:t=-8.790～-5.803,P＜0.05；NDI:t 10.717 ～ 13.514,P＜0.05),但两组之间差异无统计学意义(P＞0.05).两组患者术后颈椎活动度较术前均明显降低,Hybrid组由术前46°±11°降至术后6个月的41°±8°(t=3.170,P＜0.05),ACDF组由术前的45°±13°降至术后6个月的38°±15°(t=6.709,P＜0.05),但两组之间差异无统计学意义(P＞0.05).Hybrid组患者术后1、3个月上位相邻节段和下位相邻节段的颈椎活动度较术前均降低,差异有统计学意义(上位:t=5.622和4.032,P＜0.05；下位:t=2.879和2.207,P＜0.05),术后6个月时差异无统计学意义(P＞0.05).ACDF组术后颈椎相邻节段活动度术后3、6个月时下位相邻节段颈椎活动度较术前升高,差异有统计学意义(t=-7.038和- 13.540,P＜0.05),术后6个月时上位相邻节段颈椎活动度较术前升高,差异有统计学意义(t=-2.453,P＜0.05).结论 双节段Hybrid手术对于治疗颈椎病拥有满意的临床疗效和影像学结果,Hybrid手术患者在随访期间相邻节段颈椎活动度降低,而ACDF手术患者在随访期间相邻节段颈椎活动度增加.Hybrid手术的远期临床效果,还需要进一步随访验证.
目的 評估頸椎人工間盤置換結閤頸椎椎間融閤(Hybrid手術)治療頸椎病的臨床療效及其對相鄰頸椎節段的影響.方法 迴顧性分析2007年12月至2010年6月共17例因頸椎病行雙節段Hybrid手術患者(Hybrid組)的臨床資料,選取同期行頸椎前路減壓融閤手術(ACDF)的17例患者作為對照(ACDF組).對兩組患者術前、術後1、3、6箇月的日本骨科協會評分(JOA)、頸椎功能障礙指數評分( NDI)、C2～7整體活動度、手術相鄰頸椎節段活動度等結果進行對照評價.結果 Hybrid組和ACDF組患者術後JOA評分、NDI評分較術前均有改善(JOA:t=-8.790～-5.803,P＜0.05；NDI:t 10.717 ～ 13.514,P＜0.05),但兩組之間差異無統計學意義(P＞0.05).兩組患者術後頸椎活動度較術前均明顯降低,Hybrid組由術前46°±11°降至術後6箇月的41°±8°(t=3.170,P＜0.05),ACDF組由術前的45°±13°降至術後6箇月的38°±15°(t=6.709,P＜0.05),但兩組之間差異無統計學意義(P＞0.05).Hybrid組患者術後1、3箇月上位相鄰節段和下位相鄰節段的頸椎活動度較術前均降低,差異有統計學意義(上位:t=5.622和4.032,P＜0.05；下位:t=2.879和2.207,P＜0.05),術後6箇月時差異無統計學意義(P＞0.05).ACDF組術後頸椎相鄰節段活動度術後3、6箇月時下位相鄰節段頸椎活動度較術前升高,差異有統計學意義(t=-7.038和- 13.540,P＜0.05),術後6箇月時上位相鄰節段頸椎活動度較術前升高,差異有統計學意義(t=-2.453,P＜0.05).結論 雙節段Hybrid手術對于治療頸椎病擁有滿意的臨床療效和影像學結果,Hybrid手術患者在隨訪期間相鄰節段頸椎活動度降低,而ACDF手術患者在隨訪期間相鄰節段頸椎活動度增加.Hybrid手術的遠期臨床效果,還需要進一步隨訪驗證.
목적 평고경추인공간반치환결합경추추간융합(Hybrid수술)치료경추병적림상료효급기대상린경추절단적영향.방법 회고성분석2007년12월지2010년6월공17례인경추병행쌍절단Hybrid수술환자(Hybrid조)적림상자료,선취동기행경추전로감압융합수술(ACDF)적17례환자작위대조(ACDF조).대량조환자술전、술후1、3、6개월적일본골과협회평분(JOA)、경추공능장애지수평분( NDI)、C2～7정체활동도、수술상린경추절단활동도등결과진행대조평개.결과 Hybrid조화ACDF조환자술후JOA평분、NDI평분교술전균유개선(JOA:t=-8.790～-5.803,P＜0.05；NDI:t 10.717 ～ 13.514,P＜0.05),단량조지간차이무통계학의의(P＞0.05).량조환자술후경추활동도교술전균명현강저,Hybrid조유술전46°±11°강지술후6개월적41°±8°(t=3.170,P＜0.05),ACDF조유술전적45°±13°강지술후6개월적38°±15°(t=6.709,P＜0.05),단량조지간차이무통계학의의(P＞0.05).Hybrid조환자술후1、3개월상위상린절단화하위상린절단적경추활동도교술전균강저,차이유통계학의의(상위:t=5.622화4.032,P＜0.05；하위:t=2.879화2.207,P＜0.05),술후6개월시차이무통계학의의(P＞0.05).ACDF조술후경추상린절단활동도술후3、6개월시하위상린절단경추활동도교술전승고,차이유통계학의의(t=-7.038화- 13.540,P＜0.05),술후6개월시상위상린절단경추활동도교술전승고,차이유통계학의의(t=-2.453,P＜0.05).결론 쌍절단Hybrid수술대우치료경추병옹유만의적림상료효화영상학결과,Hybrid수술환자재수방기간상린절단경추활동도강저,이ACDF수술환자재수방기간상린절단경추활동도증가.Hybrid수술적원기림상효과,환수요진일보수방험증.
Objective To evaluate the clinical and radiologic outcomes of the Hybrid surgery (cervical artificial disc replacement combined with anterior cervical discectomy and fusion(ACDF) ) and the effective of the adjacent segment.Methods Between December 2007 to June 2010,34 patients underwent 2-level cervical disc surgery.There were 17 patients underwent Hybrid surgery( Hybrid group),17 patients underwent 2-level ACDF (ACDF group).Japanese orthopaedic association (JOA),neck disability index (NDI),and Odom's standards were evaluated. Dynamic flexion and extension lateral cervical radiographs were obtained in the standing position before surgery and at routine postoperative intervals of 1,3,6 months.Results Both of the two groups had significantly improvement than preoperative in JOA ( t =- 8.790--5.803,P ＜ 0.05 ) and NDI scores ( t =10.717-13.514,P ＜ 0.05 ),but no significantly difference between the two groups ( P ＞ 0.05 ).Both of the two groups had significantly decreased in the mean C2-7 range of motion(ROM).The Hybrid group decreased from 46° ± 11° preoperative to 41° ± 8° at the 6 mouths after surgery (t =3.170,P ＜ 0.05 ).The ACDF group decreased from 45° ± 13°preoperative to 38° ± 15°at the 6 mouths after surgery ( t =6.709,P ＜ 0.05 ).But there were no significantly difference between the two groups(P ＞ 0.05).In the Hybrid group,both the superior adjacent segment ROM and the inferior adjacent segment ROM were decreased in the follow-up,there had significantly difference at the 1 and 3 months after surgery ( superior adjacent segment:t =5.622 and 4.032,P ＜ 0.05 ; inferior adjacent segment:t =2.879 and 2.207,P ＜ 0.05),but no significantly difference after 6 months ( P ＞ 0.05).In the ACDF group,the ROM of the inferior adjacent segment was significantly increased at 3 and 6 months after surgery ( t =- 7.038 and - 13.540,P ＜ 0.05 ),the ROM of the superior adjacent segment was significantly increased at 6 months after surgery ( t =- 2.453,P ＜ 0.05 ).Conclusions Hybrid surgery has excellent clinical results and decreases the ROM of the adjacent segment in the following 6 months,meanwhile 2-level ACDF increases the ROM of the adjacent segment.The long-term clinical outcomes of the Hybrid surgery need more study.
