| 两种前路Hybrid技术治疗多节段脊髓型颈椎病的比较 |
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投稿时间：2018-06-19
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| 作者 | Author | 单位 | Address | E-Mail |
| 唐步顺 |
TANG Bu-shun |
永康市第一人民医院骨一科, 浙江 永康 321300 |
The First Department of Orthopaedics, the First People's Hospital of Yongkang, Yongkang 321300, Zhejiang, China |
tangbushun1111@126.com |
| 颜程 |
YAN Cheng |
永康市第一人民医院骨一科, 浙江 永康 321300 |
The First Department of Orthopaedics, the First People's Hospital of Yongkang, Yongkang 321300, Zhejiang, China |
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| 张小克 |
ZHANG Xiao-ke |
永康市第一人民医院骨一科, 浙江 永康 321300 |
The First Department of Orthopaedics, the First People's Hospital of Yongkang, Yongkang 321300, Zhejiang, China |
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| 刘奕兵 |
LIU Yi-bing |
永康市第一人民医院骨一科, 浙江 永康 321300 |
The First Department of Orthopaedics, the First People's Hospital of Yongkang, Yongkang 321300, Zhejiang, China |
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| 王超 |
WANG Chao |
永康市第一人民医院骨一科, 浙江 永康 321300 |
The First Department of Orthopaedics, the First People's Hospital of Yongkang, Yongkang 321300, Zhejiang, China |
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| 魏冰 |
WEI Bing |
永康市第一人民医院骨一科, 浙江 永康 321300 |
The First Department of Orthopaedics, the First People's Hospital of Yongkang, Yongkang 321300, Zhejiang, China |
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| 期刊信息：《中国骨伤》2018年，第31卷，第11期，第1034-1040页 |
| DOI：10.3969/j.issn.1003-0034.2018.11.010 |
| 基金项目:浙江省金华市科技局社会发展类重点项目（编号：2015-3-026） |
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中文摘要:
目的：比较两种前路Hybrid技术治疗多节段（≥ 3）脊髓型颈椎病的疗效和并发症。
方法：回顾性分析2008年1月至2016年12月手术治疗并获得随访的124例多节段（≥ 3）脊髓型颈椎病患者的临床资料。根据手术方式不同分为两组：A组，Smith-Robinson经椎间隙减压融合术（ACDF）加保留后壁的椎体次全切除减压融合术（PWCF）；B组，ACDF加椎体次全切除减压融合术（ACCF）。其中A组男44例，女16例，年龄（60.43±7.52）岁；B组男46例，女18例，年龄（61.61±6.39）岁；两组患者性别、年龄比较差异无统计学意义。对两组患者的手术时间、术中出血量、住院时间、并发症发生率、术后JOA评分、颈椎生理曲度改善情况进行比较。
结果：所有患者手术顺利，随访时间A组13~28（23.0±12.1）个月，B组12~30（24.0±11.5）个月。B组患者手术时间、术中出血量、住院时间均高于A组（P<0.05）。共有37例患者出现并发症，其中A组14例，B组23例。A组患者并发症发生率为23.33%（14/60），B组为35.94%（23/64），B组并发症发生率高于A组（P<0.05）。术后JOA评分均较术前明显改善（P<0.01），组间比较差异无统计学意义（P>0.05）。术后颈椎生理曲度均得到明显改善，组间比较差异也无统计学意义（P>0.05）。
结论：对于多节段（≥ 3）脊髓型颈椎病的手术治疗，两种手术方式均取得了显著的疗效，但相对于B组（ACDF+ACCF），A组（ACDF加PWCF）手术时间短、创伤小、出血量少、并发症发生率低，针对符合适应证的患者可以优先选择。 |
| 【关键词】前路减压 Hybrid手术 多节段脊髓型颈椎病 手术后并发症 |
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| Comparative analysis of two hybrid technique in treating multilevel cervical spondylotic myelopathy via anterior approach |
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ABSTRACT
Objective: To compare the clinical effects and complications of two hybrid decompression techniques in treating multilevel (≥ 3) cervical spondylotic myelopathy (MCSM).
Methods: The clinical data of 124 patients with multilevel (≥ 3) cervical spondylotic myelopathy treated by surgery and follow-up from January 2008 to December 2016 were retrospectively analyzed. According to the different operative methods, the patients were divided into group A and group B. Anterior cervical discectomy and fusion (ACDF) combined with anterior cervical corpectomy and fusion with preserved posterior vertebral wall (PWCF) were performed in group A; ACDF combined with anterior cervical corpectomy and fusion (ACCF) were performed in group B. There were 44 males and 16 females in group A with an average age of (60.43±7.52) years old, 46 males and 18 females in group B with an average age of (61.61±6.39) years old. No significant differences were found in gender, age between two groups. The operative time, intraoperative blood loss, hospital stay, rate of complications, postoperative Japanese Orthopaedic Association (JOA) score and improvement of cervical curvature were compared between two groups.
Results: All the operations were successful. The follow-up time was 13 to 28 (23.0±12.1) months in group A and 12 to 30 (24.0±11.5) months in group B. The operative time, intraoperative blood loss, hospital stay in group B were higher than those in group A (P<0.05). A total of 37 patients occurred complications, including 14 cases in group A and 23 cases in group B. The incidence of complications was 23.33% (14/60) in group A and 35.94% (23/64) in group B. The incidence of complications in group B was significantly higher than that in group A (P<0.05). Postoperative JOA scores were significantly improved (P<0.01), there was no significant difference between two groups (P>0.05). The physiological curvature of cervical vertebra was improved significantly after operation, and there was no significant difference between two groups (P>0.05).
Conclusion: Both surgical methods can obtain satisfactory clinical efficacy for multilevel (≥ 3) cervical spondylotic myelopathy, but compare with group B (ACDF combined with ACCF), group A (ACDF combined with PWCF) has shorter operation time, less trauma, less bleeding, and lower incidence of complications. ACDF combined with PWCF can be preferentially selected for the patients who corresponding to the indications. |
| KEY WORDS Anterior decompression Hybrid surgery Multilevel cervical spondylotic myelopathy Postoperative complications |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 唐步顺,颜程,张小克,刘奕兵,王超,魏冰.两种前路Hybrid技术治疗多节段脊髓型颈椎病的比较[J].中国骨伤,2018,31(11):1034~1040 |
| 英文格式: | TANG Bu-shun,YAN Cheng,ZHANG Xiao-ke,LIU Yi-bing,WANG Chao,WEI Bing.Comparative analysis of two hybrid technique in treating multilevel cervical spondylotic myelopathy via anterior approach[J].zhongguo gu shang / China J Orthop Trauma ,2018,31(11):1034~1040 |
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