中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2013年
26期
30-33
,共4页
杨小奇%齐新生%茅治湘%赵锡江
楊小奇%齊新生%茅治湘%趙錫江
양소기%제신생%모치상%조석강
脊柱融合术%脊髓型颈椎病
脊柱融閤術%脊髓型頸椎病
척주융합술%척수형경추병
Spine fusion%Cervical spondylotic myelopathy
目的 比较多节段脊髓型颈椎病(病变节段≥3个)采用两种颈前路减压植骨融合术治疗的疗效.方法 选择23例多节段脊髓型颈椎病患者,其中采用颈前路椎间盘切除减压融合术(ACDF)治疗10例(ACDF组),颈前路椎体次全切除减压融合术(ACCF)治疗13例(ACCF组).比较两组患者手术时间、术中出血量、JOA评分、神经功能改善率以及手术前后颈椎曲线深度D值变化量.结果 ACDF组手术时间和术中出血量分别为(130.0±31.5) min、(150.0±120.8) ml,均低于ACCF组的(150.0±42.5) min、(310.0±320.8) ml,差异均有统计学意义(P＜0.05);ACDF组术后颈椎曲线深度D值变化量为(3.1±1.4) mm,高于ACCF组的(2.3±0.9) mm,差异有统计学意义(P＜0.05);ACDF组JOA评分差值和神经功能改善率分别为(4.5±1.6)分、79.3％,ACCF组分别为(4.6±1.2)分、80.2％,两组比较差异无统计学意义(P＞0.05).ACDF组出现脑脊液漏2例,经压迫及引流等治疗后恢复.ACCF组术后14d出现食管瘘并发症1例,经修补后痊愈;出现钛网移位2例,经随访获得融合.结论 ACDF与ACCF治疗多节段脊髓型颈椎病均能取得良好的减压效果,术后疗效良好.ACDF与ACCF比较手术时间短、术中出血量小、保持颈椎生理曲度的效果更优.
目的 比較多節段脊髓型頸椎病(病變節段≥3箇)採用兩種頸前路減壓植骨融閤術治療的療效.方法 選擇23例多節段脊髓型頸椎病患者,其中採用頸前路椎間盤切除減壓融閤術(ACDF)治療10例(ACDF組),頸前路椎體次全切除減壓融閤術(ACCF)治療13例(ACCF組).比較兩組患者手術時間、術中齣血量、JOA評分、神經功能改善率以及手術前後頸椎麯線深度D值變化量.結果 ACDF組手術時間和術中齣血量分彆為(130.0±31.5) min、(150.0±120.8) ml,均低于ACCF組的(150.0±42.5) min、(310.0±320.8) ml,差異均有統計學意義(P＜0.05);ACDF組術後頸椎麯線深度D值變化量為(3.1±1.4) mm,高于ACCF組的(2.3±0.9) mm,差異有統計學意義(P＜0.05);ACDF組JOA評分差值和神經功能改善率分彆為(4.5±1.6)分、79.3％,ACCF組分彆為(4.6±1.2)分、80.2％,兩組比較差異無統計學意義(P＞0.05).ACDF組齣現腦脊液漏2例,經壓迫及引流等治療後恢複.ACCF組術後14d齣現食管瘺併髮癥1例,經脩補後痊愈;齣現鈦網移位2例,經隨訪穫得融閤.結論 ACDF與ACCF治療多節段脊髓型頸椎病均能取得良好的減壓效果,術後療效良好.ACDF與ACCF比較手術時間短、術中齣血量小、保持頸椎生理麯度的效果更優.
목적 비교다절단척수형경추병(병변절단≥3개)채용량충경전로감압식골융합술치료적료효.방법 선택23례다절단척수형경추병환자,기중채용경전로추간반절제감압융합술(ACDF)치료10례(ACDF조),경전로추체차전절제감압융합술(ACCF)치료13례(ACCF조).비교량조환자수술시간、술중출혈량、JOA평분、신경공능개선솔이급수술전후경추곡선심도D치변화량.결과 ACDF조수술시간화술중출혈량분별위(130.0±31.5) min、(150.0±120.8) ml,균저우ACCF조적(150.0±42.5) min、(310.0±320.8) ml,차이균유통계학의의(P＜0.05);ACDF조술후경추곡선심도D치변화량위(3.1±1.4) mm,고우ACCF조적(2.3±0.9) mm,차이유통계학의의(P＜0.05);ACDF조JOA평분차치화신경공능개선솔분별위(4.5±1.6)분、79.3％,ACCF조분별위(4.6±1.2)분、80.2％,량조비교차이무통계학의의(P＞0.05).ACDF조출현뇌척액루2례,경압박급인류등치료후회복.ACCF조술후14d출현식관루병발증1례,경수보후전유;출현태망이위2례,경수방획득융합.결론 ACDF여ACCF치료다절단척수형경추병균능취득량호적감압효과,술후료효량호.ACDF여ACCF비교수술시간단、술중출혈량소、보지경추생리곡도적효과경우.
Objective To compare the clinical results of two different anterior cervical surgical treatment for multi-segmental cervical spondylotic myelopathy (≥3 segments).Methods Twenty-three patients with segmental cervical spondylotic myelopathy,10 cases were treated with anterior cervical discectomy and fusion (ACDF) as ACDF group,13 cases were treated with anterior cervical corpectomy and fusion (ACCF) as ACCF group.The operation time,operative blood loss,JOA scores,neurological improvement rate and the variable of the D value were compared.Results The operation time and operative blood loss in ACDF group was significantly lower than that in ACCF group [(130.0 ±31.5) min vs.(150.0 ±42.5) min,(150.0 ± 120.8) ml vs.(310.0 ± 320.8) ml,P ＜ 0.05].The variable of the D value in ACDF group was significantly higher than that in ACCF group [(3.1 ± 1.4) mm vs.(2.3 ± 0.9) mm,P ＜ 0.05].There was no statistically significant difference in JOA scores,neurological improvement rate between ACDF group and ACCF group.Two cases of cerebrospinal fluid leakage in ACDF group,the oppression and drainage recovery after treatment.One case of 14 d after fistula complications in ACCF group,after patching were cured; 2 cases of titanium mesh shift,follow the fusion.Conclusions Both methods attain good clinical results.ACDF combined with ACCF treatment of multi-segmental cervical spondylotic myelopathy,with shorter operation time,relatively less blood loss,and better restoration of cervical sagittal alignment.
