| 前路不同手术方式治疗单节段颈椎间盘突出症的疗效比较 |
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投稿时间：2020-02-06
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| 作者 | Author | 单位 | Address | E-Mail |
| 范亚一 |
FAN Ya-yi |
陕西省人民医院骨科病院, 陕西 西安 710068 |
Orthopedic Hospital of Shaanxi People's Hospital, Xi'an 710068, Shannxi, China |
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| 段亮 |
DUAN Liang |
陕西省人民医院骨科病院, 陕西 西安 710068 |
Orthopedic Hospital of Shaanxi People's Hospital, Xi'an 710068, Shannxi, China |
duanliang0620@163.com |
| 徐洪海 |
XU Hong-hai |
陕西省人民医院骨科病院, 陕西 西安 710068 |
Orthopedic Hospital of Shaanxi People's Hospital, Xi'an 710068, Shannxi, China |
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| 刘军 |
LIU Jun |
陕西省人民医院骨科病院, 陕西 西安 710068 |
Orthopedic Hospital of Shaanxi People's Hospital, Xi'an 710068, Shannxi, China |
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| 祁洁 |
QI Jie |
陕西省人民医院骨科病院, 陕西 西安 710068 |
Orthopedic Hospital of Shaanxi People's Hospital, Xi'an 710068, Shannxi, China |
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| 弓立群 |
GONG Li-qun |
陕西省人民医院骨科病院, 陕西 西安 710068 |
Orthopedic Hospital of Shaanxi People's Hospital, Xi'an 710068, Shannxi, China |
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| 期刊信息：《中国骨伤》2021年，第34卷，第4期，第354-359页 |
| DOI：10.12200/j.issn.1003-0034.2021.04.012 |
| 基金项目:陕西省自然科学基金（编号：2014JQ4125） |
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中文摘要:
目的： 比较前路不同手术方式治疗单节段颈椎间盘突出症患者的临床疗效。
方法： 对2013年9月至2018年9月手术治疗的46例单节段颈椎间盘突出症患者临床资料进行回顾性分析，按不同的手术方法将患者分为3组，其中经皮前路椎间孔镜下颈椎间盘髓核摘除术（anterior percutanousendomic cervical dissection，APECD）组23例，男8例，女15例，年龄（47±3）岁，突出节段C3，4 1例，C4，5 6例，C5，6 16例；颈椎间盘置换术（cervical disc replacement，CDR）组10例，男4例，女6例，年龄（46±3）岁，突出节段C3，4 1例，C4，5 6例，C5，6 3例；经颈前路椎间盘切除减压融合术（anterior cervical disc fusion，ACDF）组13例，男8例，女5例，年龄（53±2）岁，突出节段C3，4 1例，C4，5 3例，C5，6 9例。对3组患者的手术时间、术中出血量、住院时间进行比较；并采用疼痛视觉模拟评分（visual analogue scale，VAS）及日本骨科协会（Japanese Orthopaedic Association，JOA）评分评价3组患者的临床疗效。
结果： 46例患者均获得随访，时间12~24（17.57±3.15）个月。APECD，CDR，ACDF组随访时间分别为（17.30±3.25），（17.80±3.16），（17.85±2.88）个月，两两比较差异均无统计学意义（P>0.05）；手术时间分别为（95.48±13.85），（58.50±7.09），（76.00±15.72） min，两两比较差异均有统计学意义（P<0.05）；术中出血量分别（80.00±20.22），（82.60±7.20），（121.54±18.75） ml，CDR组和ACDF组比较差异有统计学意义（P<0.05），其余比较差异无统计学意义（P>0.05）；3组住院时间分别为（6.95±1.50），（6.60±0.80），（6.54±0.75） d，两两比较差异无统计学意义（P>0.05）。末次随访时VAS评分APECD组从术前的6.78±0.83降到2.57±0.65；CDR组从术前的5.70±0.78降到2.00±0.45；ACDF组从术前的6.77±0.42降低到1.38±0.49；JOA评分APECD组从术前的8.91±0.97增加到13.04±1.40，改善率（65±15）%；CDR从术前的11.50±1.20增加到14.90±1.14，改善率（76±19）%；ACDF组从术前的8.54±0.93增加到14.00±0.96，改善率（74±8）%。各组改善率之间两两比较APECD组和CDR组差异有统计学意义（P<0.05）。末次随访时APECD组和CDR组责任节段活动度均良好保留，并有所改善（P<0.05）。APECD组在中期随访（术后4和6个月）中出现2例症状复发，其中1例严格保守治疗后好转；另1例二次行ACDF手术，术后随访疗效满意。
结论： 3种前路手术方式治疗单节段颈椎间盘突出症均可获得满意的临床疗效，但CDR改善率及保留责任节段活动度优于其他两种术式，APECD有复发的可能。 |
| 【关键词】颈椎 椎间盘移位 外科手术 |
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| Comparison of clinical effects of different anterior surgical methods for the treatment of single segment cervical disc herniation |
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ABSTRACT
Objective: To compare the clinical effects of different anterior surgical methods in treating single segment cervical disc herniation.
Methods: The clinical data of 46 patients with single-segment cervical disc herniation underwent surgical treatment from September 2013 to September 2018 were retrospectively analyzed. The patients were divided into three groups according to different surgical methods. Among them,23 patients in the anterior percutanousendomic cervical dissection (APECD) group,there were 8 males and 15 females,aged(47±3) years old,prominent segments were C3,4 of 1 case,C4,5 of 6 cases,and C5,6 of 16 cases;10 patients in cervical disc replacement(CDR) group,there were 4 males and 6 females,aged (46±3) years old,prominent segments were C3,4 of 1 case,C4,5 of 6 cases,C5,6 of 3 cases;13 patients in transcervical anterior cervical disc fusion(ACDF) group,there were 8 males and 5 females,aged (53±2) years old,protruding segments were C3,4 of 1 case,C4,5 of 3 cases,C5,6 of 9 cases. The operation time,intraoperative blood loss,and length of hospitalization were compared among three groups;visual analogue scale (VAS) and Japanese Orthopaedic Association(JOA) score were used to evaluate the clinical efficacy.
Results: All 46 patients were followed up for 12 to 24(17.57±3.15) months. The follow-up time of APECD,CDR,ACDF groups were (17.30±3.25),(17.80±3.16),(17.85±2.88) months,and operation time were(95.48±13.85),(58.50±7.09),(76.00±15.72) min,respectively,there were no significant differences in follow-up time and operation time between two groups(P>0.05). The intraoperative blood loss of APECD,CDR,ACDF groups were (80.00±20.22),(82.60±7.20),(121.54±18.75) ml,there was significant difference between CDR group and ACDF group(P<0.05);and there was no significant difference between other groups(P>0.05). The length of hospitalization was(6.95±1.50) days in APECD group,(6.60±0.80) days in CDR group,(6.54±0.75) days in ACDF group,and there was no significant difference between two groups(P>0.05). At the latest follow-up,VAS scores were decreased from preoperative 6.78±0.83 to 2.57±0.65 in APECD group,decreased from 5.70±0.78 to 2.00±0.45 in CDR group,decreased from 6.77±0.42 to 1.38±0.49 in ACDF group. The JOA scores at final follow-up were increased from 8.91±0.97 to 13.04±1.40 in APECD group,and the improvement rate of (65±15)%;increased from 11.50±1.20 to 14.90±1.14 in CDR group,and the improvement rate of(76±19)%;increased from 8.54±0.93 to 14.00±0.96 in ACDF group,and the improvement rate of(74±8)%;there was significant difference in improvement rate between APECD group and CDR group(P<0.05). At final follow-up,the activities of the responsible segment in APECD group and CDR group were well preserved and improved (P<0.05). In the APECD group,the symptoms of two cases recurred during the mid-term follow-up(4 months and 6 months after surgery),one of which improved after strictly conservative treatment;the other one received ACDF surgery a second time,and the postoperative follow-up effect was satisfactory.
Conclusion: The three anterior surgical approaches can achieve satisfactory clinical results for the treatment of single-segment cervical disc herniation. However,the improvement rate of the CDR group and the activity of the retained responsibility segment are better than those of the other two groups. APECD surgery may have recurrence. |
| KEY WORDS Cervical vertebrae Intervertebral disc displacement Surgical procedures,operative |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 范亚一,段亮,徐洪海,刘军,祁洁,弓立群.前路不同手术方式治疗单节段颈椎间盘突出症的疗效比较[J].中国骨伤,2021,34(4):354~359 |
| 英文格式: | FAN Ya-yi,DUAN Liang,XU Hong-hai,LIU Jun,QI Jie,GONG Li-qun.Comparison of clinical effects of different anterior surgical methods for the treatment of single segment cervical disc herniation[J].zhongguo gu shang / China J Orthop Trauma ,2021,34(4):354~359 |
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