摘要
目的:比较显微镜辅助下前路颈椎间盘切除减压椎间植骨融合术(anterior cervical discectomy and fusion,ACDF)与常规ACDF术治疗单节段脊髓型颈椎病的临床疗效。方法:回顾性分析2015年3月至2019年3月收治的89例单节段脊髓型颈椎病患者,男55例,女34例,年龄(52.00±11.36)岁;其中34例采用常规ACDF术治疗(常规组),C_(3,4)3例,C_(4,5)10例,C_(5,6)15例,C_(6,7)6例;55例采用显微镜辅助下ACDF术治疗(显微镜组),C_(3,4)5例,C_(4,5)23例,C_(5,6)20例,C_(6,7)7例。比较两组患者的手术时间、术中失血量、住院时间。术后1周、3个月、12个月采用日本骨科学会(Japanese Orthopaedic Association,JOA)评分标准,视觉疼痛模拟评分(visual analogue scale,VAS),Oswestry功能障碍指数(Oswestry Disability Index,ODI)进行临床疗效评估。结果:显微镜组失血量及住院时间均小于常规组(P<0.05),而常规组手术时间少于显微镜组(P<0.05)。两组患者术后1周、3个月及12个月JOA、VAS、ODI评分均较术前有明显改善(P<0.05)。尽管两组患者术后12个月比较差异无统计学意义(P>0.05),但术后1周、3个月显微镜组VAS评分低于常规组(P<0.05);显微镜组每次随访的JOA评分均高于常规组(P<0.05);术后3、12个月时显微镜组的ODI评分也优于常规组(P<0.05)。结论:显微镜辅助下ACDF术与同期常规ACDF术治疗单节段脊髓型颈椎病均能取得满意的临床疗效。但显微镜下行ACDF术具有视野清晰、出血少及术中并发症少的优势。
Objective:To compare the efficacy of microscope assisted anterior cervical discectomy and fusion with conventional surgical approach in the treatment of single-segment cervical spondylotic myelopathy.Methods:The clinical data of 89 patients with single-segment cervical spondylotic myelopathy treated from March 2015 to March 2019 were retrospectively analyzed.There were 55 males and 34 females,with an average of(52.00±11.36)years old.Among the patients,34 cases were treated with conventional anterior cervical discectomy with fusion(conventional group),including C_(3,4) in 3 cases,C_(4,5) in 10 cases,C_(5,6) in 15 cases,C_(6,7) in 6 cases;55 cases were treated with microscope-assisted anterior cervical discectomy with fusion(microscope group),including C3,4 in 5 cases,C_(4,5) in 23 cases,C_(5,6) in 20 cases,C_(6,7) in 7 cases.Operative time,intraoperative blood loss,hospital stay and complications were compared between two groups.Clinical efficacy was assessed by visual analogue scale(VAS),Japanese Orthopaedics Association(JOA)scores,Oswestry Disability Index(ODI)during follow-up period(postoperative 1 week,3 months and 12 months).Results:Intraoperative blood loss and hospital stay in microscope group were less than those in conventional group(P<0.05),and operative time of conventional group was shorter than that of microscope group(P<0.05).Postoperative JOA,VAS and ODI were significantly improved in each groups(P<0.05).VAS scores of microscope group were better than that of conventional group at 1 week and 3 months after operation(P<0.05),but there was no statistically significant difference between two groups at 12 months after operation(P>0.05).JOA scores of microscope group at each postoperative follow-up were better than that of conventional group(P<0.05).ODI scores of microscope group at 3,12 months after operation were better than that of conventional group(P<0.05).Conclusion:Both methods can achieve satisfactory effect in treating single-segment cervical spondylotic myelopathy.However,microscope-assisted anterior cervical discectomy and fusion has advantages of clear vision,less bleeding and fewer intraoperative complications.
作者
许宇霞
罗琦山
李远红
王永福
罗一
王强
罗为民
XU Yu-xia;LUO Qi-shan;LI Yuan-hong;WANG Yong-fu;LUO Yi;WANG Qiang;LUO Wei-min(Department of Spine Surgery,Changsha Central Hospital,University of South China,Changsha 410004,Hunan,China)
出处
《中国骨伤》
CAS
CSCD
2021年第4期327-332,共6页
China Journal of Orthopaedics and Traumatology
