CAJ | 학술논문

目的：比较经椎间隙减压植骨融合术（ anterior cervical discectomy with fusion ，ACDF）与椎体次全切减压植骨融合术（anterior cervical corpectomy with fusion ，ACCF）对相邻两节段脊髓型颈椎病患者的临床疗效。方法回顾由同一组医师行颈前路手术治疗并成功随访的33例相邻两节段颈椎病患者，根据手术方式分为两组：A组，18例患者行颈前路椎间隙减压联合椎间融合器植骨融合术；B组，15例患者行颈前路椎体次全切除减压联合钛网植骨融合术，比较两组手术时间、术中出血量、住院时间、JOA评分、颈椎曲度变化、融合节段椎间高度及植骨融合情况。结果所有患者均获得随访，时间为12～15个月，平均13．2个月。 A组手术时间长于B组，出血量少于B组，两组参数组间比较差异有统计学意义（P＜0．05）。 A组住院天数略少于B组，差异无统计学意义（P＞0．05）。两组术后3天、术后1年随访JOA评分均较术前提高，JOA评分、融合节段高度及颈椎曲度与术前相比差异均有统计学意义（P＜0．05）；但组间JOA评分及颈椎曲度差异比较无统计学意义（P＞0．05），融合节段高度差异有统计学意义（P＜0．05）。两组患者随访期间均未出现内固定松动、断裂等情况。术后1年随访均达到骨性融合的标准。结论两种方法治疗双节段颈椎病均可获得满意的临床疗效，与ACDF相比，ACCF视野清楚、操作方便、手术时间短，但手术创伤大、出血量多，在维持融合节段高度方面比ACDF差，存在钛网下沉现象。
목적：비교경추간극감압식골융합술（ anterior cervical discectomy with fusion ，ACDF）여추체차전절감압식골융합술（anterior cervical corpectomy with fusion ，ACCF）대상린량절단척수형경추병환자적림상료효。방법회고유동일조의사행경전로수술치료병성공수방적33례상린량절단경추병환자，근거수술방식분위량조：A조，18례환자행경전로추간극감압연합추간융합기식골융합술；B조，15례환자행경전로추체차전절제감압연합태망식골융합술，비교량조수술시간、술중출혈량、주원시간、JOA평분、경추곡도변화、융합절단추간고도급식골융합정황。결과소유환자균획득수방，시간위12～15개월，평균13．2개월。 A조수술시간장우B조，출혈량소우B조，량조삼수조간비교차이유통계학의의（P＜0．05）。 A조주원천수략소우B조，차이무통계학의의（P＞0．05）。량조술후3천、술후1년수방JOA평분균교술전제고，JOA평분、융합절단고도급경추곡도여술전상비차이균유통계학의의（P＜0．05）；단조간JOA평분급경추곡도차이비교무통계학의의（P＞0．05），융합절단고도차이유통계학의의（P＜0．05）。량조환자수방기간균미출현내고정송동、단렬등정황。술후1년수방균체도골성융합적표준。결론량충방법치료쌍절단경추병균가획득만의적림상료효，여ACDF상비，ACCF시야청초、조작방편、수술시간단，단수술창상대、출혈량다，재유지융합절단고도방면비ACDF차，존재태망하침현상。
Objective To compare the clinical effects of anterior cervical discectomy with fusion ( ACDF) and anterior cervical cor-pectomy with fusion(ACCF) for treating adjacent two -level cervical spondylitic myelopathy .Methods The clinical data of 33 patients suf-fered from two-level cervical spondylosis (17 males and 16 female;age range,45-70 years;mean age,55 years) who were treated by the same orthopedist with anterior surgical procedures between Aug 2009 and Aug 2012 were retrospectively reviewed .Eighteen of them that un-derwent anterior decompression with cervical bone grafting and fusion with cage made up group A ,while other fifteen patients that underwent anterior cervical corpectomy with preserved posterior vertebral wall combined with titanium mesh fusion made up Group B .The evaluation in-dex included duration of operation ,intraoperative blood loss ,the hospitalization duration ,Japanese Orthopaedic Association ( JOA) score evalu-ation,change of cervical vertebrae curvature ( CVC) and intervertebral height ,situation of fusion after bone trans -plantation.Results All of the patients were followed up for 12 to 15 months with a mean time of 13.2 months.Operative time of group A was less than that of group B (P<0.05).Volume of loss blood during operation in group B was less than that in group A (P<0.05).The duration of operation in group A was less than that in group B,but the difference was't statistically significant(P>0.05) .Postoperative JOA score,the CVC and interverte-bral height in 3 days and 12 months were improved (P<0.05),whereas there was no significant difference in JOA score and the CVC in all periods between the two groups(P>0.05).The cervical lordosis in group B was superior to that of group A (P<0.05).Neither of the groups had implantation loosening or breakage .The spinal fusion rate was 100%.Conclusion Both methods can obtain satisfactory effects in trea-ting two-level cervical spondylitic myelopathy .ACCF has advantages of clear view and simple operation ,but can result in severe trauma and more blood loss.Moreover,the method in aspect of keeping fusion segment height is poorer than that of ACDF .Mesh subsidence may occur with this method .