| 颈椎前路Hybrid手术的短期临床疗效观察 |
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Received:July 21, 2021
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| 作者 | Author | 单位 | Unit | E-Mail |
| 陈超 |
CHEN Chao |
首都医科大学附属北京中医医院, 北京 100010 |
Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing 100010, China |
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| 柳根哲 |
LIU Gen-zhe |
首都医科大学附属北京中医医院, 北京 100010 |
Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing 100010, China |
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| 尹辛成 |
YIN Xin-cheng |
首都医科大学附属北京中医医院, 北京 100010 |
Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing 100010, China |
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| 彭亚 |
PENG Ya |
首都医科大学附属北京中医医院, 北京 100010 |
Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing 100010, China |
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| 郑皓云 |
ZHENG Hao-yun |
首都医科大学附属北京中医医院, 北京 100010 |
Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing 100010, China |
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| 祝永刚 |
ZHU Yong-gang |
首都医科大学附属北京中医医院, 北京 100010 |
Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing 100010, China |
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| 赵思浩 |
ZHAO Si-hao |
首都医科大学附属北京中医医院, 北京 100010 |
Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing 100010, China |
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| 李春根 |
LI Chun-gen |
首都医科大学附属北京中医医院, 北京 100010 |
Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing 100010, China |
leechungen1953@163.com |
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| 期刊信息：《中国骨伤》2022年35卷，第8期，第740-746页 |
| DOI：10.12200/j.issn.1003-0034.2022.08.008 |
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目的：探讨颈椎前路Hybrid手术治疗双节段及3节段颈椎病短期临床疗效。
方法：收集2018年1月至2019年1月行双节段或3节段Hybrid手术108例颈椎退行性疾病的住院患者，根据手术节段数目不同将患者分为双节段组52例和3节段组56例，其中双节段组男24例，女28例，年龄35~67（45.94±14.67）岁；3节段组男23例，女33例，年龄32~65（47.54±15.34）岁。比较两组的结局指标，其中临床指标采用颈椎功能障碍指数（neck disability index，NDI）评价患者日常活动能力，日本骨科协会（Japanese Orthopedic Association，JOA）评分评价神经功能改善情况，疼痛视觉模拟评分（visual analogue scale，VAS）评价疼痛强度，根据Odom's评分对一般临床结果进行分级；并通过X线、CT及MRI测量颈椎活动度、融合情况及并发症等。
结果：所有患者手术顺利完成，且获得12个月以上的随访。双节段组和3节段组手术时间分别为95~180（152.30±44.74） min和110~210（165.18±45.86） min，出血量分别为20~100（32.88±8.75） ml和20~150（34.64±10.63） ml，组间比较差异无统计学意义（P > 0.05）。两组患者术后12个月NDI、JOA、VAS、Odom's评分较术前有较大改善（P<0.05），NDI、JOA、Odom's评分组间比较差异均无统计学意义（P>0.05），VAS3节段组高于双节段组。两组术后C3-C7颈椎活动度比较差异均无统计学意义（P>0.05）。全部患者手术切口顺利愈合，无脊髓损伤、脑脊液漏等并发症发生，两组骨融合率分别为43例（82.69%）和45例（80.35%）；双节段组出现2例邻近节段骨质增生，3节段组出现3例邻近节段骨质增生、1例邻近节段后纵韧带骨化；此外，3节段组有1例融合器松动，不伴随明显临床症状。
结论：应用前路Hybrid术式治疗多节段颈椎病，既改善了患者的临床症状，也极大地保留了颈椎的活动度，同时也证实了Hybrid在多节段颈椎间盘疾病中的有效性和安全性。 |
| [关键词]:颈椎前路手术 Hybrid手术 颈椎病 手术疗效 |
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| Short term clinical observation of cervical anterior Hybrid surgery |
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Abstract:
Objective: To investigate the short-term clinical effect of the cervical anterior Hybrid surgery in the treatment of two-segment and three-segment cervical spondylosis.
Methods: From January 2018 to January 2019, 108 patients who were performed anterior Hybrid surgery with cervical degenerative diseases were collected. The patients were divided into a two-segment group with 52 patients and a three-segment group with 56 patients according to surgical segments. In two-segment group, there were 24 males and 28 females, aged from 35 to 67 years old with an average of(45.94±14.67) years old. In three-segment group, there were 23 males and 33 females, aged from 32 to 65 years old with an average of (47.54±15.34) years old. The outcome indicators of the two groups were compared. Clinical indicators:neck disability index(NDI) was used to evaluate daily life ability, Japanese Orthopedic Association(JOA) score was used to evaluate neurological function improvement, visual analogue scale(VAS) was used to evaluate pain intensity, and general clinical results were graded according to Odom's score. Cervical range of motion (ROM), fusion and complications were measured by X-ray, CT and MRI.
Results: All operations were successfully completed and all patients were followed up for more than 12 months. The operation time of two-segment group and three-segment group were 95 to 180 min with an average of(152.30±44.74) min and 110 to 210 min with an average of (165.18±45.86) mins, the blood loss were 20 to 100 ml with an average of (32.88±8.75) ml and 20 to 150 ml with an average of(34.64±10.63) ml respectively which has no statistical differences between the two groups (P>0.05). Compared with those before surgery, NDI, JOA, VAS and Odom's scores between two groups were significantly improved at 12 months after operation(P<0.05). However, there was no significant difference in the NDI, JOA and Odom's scores between two groups (P>0.05), and VAS in three-segment group was higher than that in two-segment group. There was no significant difference in C3-C7 cervical mobility between two groups. Surgical incisions healed smoothly in all patients without complication such as spinal cord injury and cerebrospinal fluid leakage. The bone fusion of the two groups were 43 cases (82.69%) and 45 cases(80.35%) respectively. In two-segment group, there were 2 cases of adjacent segmental hyperosteogeny, and there were 3 cases of adjacent segmental hyperosteogeny and 1 case of adjacent posterior longitudinal ligament ossification in the three-segment group. In addition, in three-segment group, there was 1 case of looseness of implants with no obvious clinical symptoms.
Conclusion: The anterior Hybrid surgery in treating multi-level cervical spondylosis could not only improve clinical symptoms of patients but also preserve mobility. Meanwhile, the efficacy and safety of Hybrid surgery in different multi-level cervical disc diseases are confirmed, proving its value in clinical practice. |
| KEYWORDS:Cervical anterior surgery Hybrid surgery Cervical spondylosis Surgical outcome |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 陈超,柳根哲,尹辛成,彭亚,郑皓云,祝永刚,赵思浩,李春根.颈椎前路Hybrid手术的短期临床疗效观察[J].中国骨伤,2022,35(8):740~746 |
| 英文格式: | CHEN Chao,LIU Gen-zhe,YIN Xin-cheng,PENG Ya,ZHENG Hao-yun,ZHU Yong-gang,ZHAO Si-hao,LI Chun-gen.Short term clinical observation of cervical anterior Hybrid surgery[J].zhongguo gu shang / China J Orthop Trauma ,2022,35(8):740~746 |
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