两种前路减压植骨融合并钛钢板置入内固定治疗相邻两个节段脊髓型颈椎病的比较

背景：颈椎前路手术减压方法主要包括环锯法颈椎前路减压融合、前路椎间盘切除植骨融合与钛板置入内固定和前路椎体次全切除植骨融合并置入钛板内固定。 目的：比较两种不同的颈椎前路减压植骨融合并钛钢板置入内固定治疗相邻两个节段脊髓型颈椎病的临床效果及生物相容性反应。 方法：相邻两节段脊髓型颈椎病患者54例按数字表法随机分为2组。27例采用前路椎间盘切除植骨融合并钛板置入内固定,27例采用前路椎体次全切除植骨融合并钛板置入内固定。比较两组融合节段高度和Cobb’s角、神经功能改善率、置入后并发症发生率。 结果与结论：两组各有4例因失随访或随访时间不到2年未纳入结果。前路椎间盘切除植骨融合并钛板置入内固定组23例随访26~48个月;前路椎体次全切除植骨融合并钛板置入内固定组23例随访24~53个月。两组住院时间,融合节段高度,脊髓功能改善率,治疗优良率和有效率差异无显著性意义(P > 0.05)。后组手术时间、术中出血量均高于前组(P < 0.05),融合节段Cobb’s角的改善也较优(P < 0.05),但供骨区并发症发生率低(P < 0.05)。提示两种方法治疗相邻两个节段脊髓型颈椎病均取得满意的疗效,前路椎间盘切除植骨融合并钛板置入内固定具有手术时间短、术中出血量少、明显改善融合节段Cobb’s角、椎体骨质保留多、减少供骨区并发症等优点。

Comparison of two anterior decompression bone fusion treatments plus titanium plate implantation for two-level cervical spondylotic myelopathy

BACKGROUND:Anterior surgical approaches for cervical spondylotic myelopathy (CSM) include Cloward method, anterior cervical discectomy and fusion or anterior cervical corpectomy and fusion. OBJECTIVE:To compare the clinical effects and biocompatibility of two different anterior approaches in combination with titanium plate implantation for two-level CSM. METHODS:A total of 54 cases of two-level CSM were randomly divided into two groups: 27 cases were treated with anterior cervical discectomy and fusion (ACDF), and 27 with anterior cervical corpectomy and fusion (ACCF). Complications, the function recovery rate of spinal cord, the height and Cobb’s angle of the fused segment between two groups. RESULTS AND CONCLUSION:Four patients in ACDF group and four in ACCF group were excluded for analysis because of follow-up lost or follow-up less than 2 years. The follow-up period of 23 patients in ACDF group was 26-48 months and of 23 patients in ACCF group was 24-53 months. There were no significant differences in hospital stay, the height of the fused segment, complications, or the function recovery rate of spinal cord between the two groups (P > 0.05). Operation time and bleeding amount were significantly greater in ACCF group compared with ACDF group (P < 0.05). Postoperative Cobb’s angle of the fused segment was significantly better in the ACDF group (P < 0.05), and incidence of complications was low in bone donor region (P < 0.05). Results show that surgical managements of two-level CSM using ACCF or ACDF obtained favorable clinical outcomes. However, ACDF was superior over ACCF in terms of operation time and bleeding amount, Cobb’s angle of the fused segment, vertebral bone reservation, elimination of donor site complications.