CAJ | 학술논문

目的：探讨不同手术方式治疗脊髓型颈椎病的临床疗效和术后并发症的发生情况。方法回顾性分析65例脊髓型颈椎病患者，其中31例行颈前路椎间盘切除融合术（ACDF），34例行颈前路椎体次全切钛网植骨钛板内固定术（ACCF），探讨两组患者手术一般情况、JOA评分和Nurick颈椎病脊髓功能分级以及吞咽困难发生情况等。结果 ACDF组患者手术时间（88．70±9．03）min、术中出血量（94．26±10．34）mL ，ACCF组患者手术时间（125．46±12．62）min、术中出血量（133．98±12．09）mL ，两组比较，ACDF组优于ACCF组，差异有统计学意义（P＜0．05）；两组患者术后住院时间、术前及术后6个月JOA评分、Nurick颈椎病脊髓功能分级比较，差异无统计学意义（P＞0．05）。ACDF组患者在同一观察时间点，吞咽困难发生率及手术节段椎前软组织厚度均低于ACCF组，差异有统计学意义（P＜0．05）；两组均未出现植骨块松动移位、植骨不融合的情况。结论两种手术方式治疗脊髓型颈椎病均可取得满意的临床疗效，ACDF具有并发症发生率低的特点。手术方式，应根据实际情况选择。
목적：탐토불동수술방식치료척수형경추병적림상료효화술후병발증적발생정황。방법회고성분석65례척수형경추병환자，기중31례행경전로추간반절제융합술（ACDF），34례행경전로추체차전절태망식골태판내고정술（ACCF），탐토량조환자수술일반정황、JOA평분화Nurick경추병척수공능분급이급탄인곤난발생정황등。결과 ACDF조환자수술시간（88．70±9．03）min、술중출혈량（94．26±10．34）mL ，ACCF조환자수술시간（125．46±12．62）min、술중출혈량（133．98±12．09）mL ，량조비교，ACDF조우우ACCF조，차이유통계학의의（P＜0．05）；량조환자술후주원시간、술전급술후6개월JOA평분、Nurick경추병척수공능분급비교，차이무통계학의의（P＞0．05）。ACDF조환자재동일관찰시간점，탄인곤난발생솔급수술절단추전연조직후도균저우ACCF조，차이유통계학의의（P＜0．05）；량조균미출현식골괴송동이위、식골불융합적정황。결론량충수술방식치료척수형경추병균가취득만의적림상료효，ACDF구유병발증발생솔저적특점。수술방식，응근거실제정황선택。
Objective To investigate the clinical therapeutic effects of different surgical treatments on cervical spondylotic my-elopathy and the occurrence of postoperative complications .Methods 65 patients with cervical spondylotic myelopathy admitted in our department between January 2010 and January 2013 were retrospectively analyzed ;and among them ,31 underwent anterior cer-vical discectomy and fusion(ACDF) and 34 underwent anterior cervical corpectomy and fusion (ACCF);the general surgical condi-tions ,JOA scores and functional grades of Nurick ,incidences of dysphagia and so on in the patients of the two groups were investi-gated .Results The operative time and intra-operative blood loss of the patients of the ACDF group were better than those of the ACCF group[(88 .70 ± 9 .03)min ,(125 .46 ± 12 .62)min ,(94 .26 ± 10 .34)mL ,(133 .98 ± 12 .09)mL] ,and the differences were sta-tistically significant(P<0 .05) .The postoperative lengths of stay of the two groups were similar ,and the differences in preoperative and postoperative JOA scores and functional grade of Nurick of the two groups were statistically insignificant (P>0 .05);but the differences between the preoperative and postoperative JOA scores and functional grade of Nurick in 6 months after the surgeries and those before the surgeries of the same groups were statistically significant (P<0 .05) .At the same observation time points ,the incidences of dysphagia and the thicknesses of soft tissue before the cervical vertebra in the operated segment of the observation group were all lower than those of the control group ,and the differences were statistically significant (P<0 .05);in the patients of either group ,no loosening ,translocation or non-fusion of the bone graft was observed .Conclusion The two surgeries in treatment of cervical spondylotic myelopathy van both obtain satisfying clinical therapeutic effects ,but ACDF has a lower incidence of postop-erative complications ,and doctors should choose a suitable surgery based on the actual conditions .