Lin Dasheng, Zhai Wenliang, Lian Kejian, Kang Liangqi, Ding Zhenqi
Orthopedics. 2013 Nov;36(11):e1431-6. doi: 10.3928/01477447-20131021-28.
The purpose of this study was to compare the results of 2 surgical strategies for 4-level cervical spondylotic myelopathy: a hybrid procedure using anterior cervical diskectomy and fusion (ACDF) combined with segmental corpectomy versus posterior laminectomy and fixation. Between 2002 and 2010, fifty-one patients with consecutive 4-level cervical spondylotic myelopathy were treated surgically, with 27 patients undergoing the hybrid procedure and 24 undergoing posterior laminectomy and fixation. Radiologic data were compared between the 2 groups, including cervical curvature and cervical range of motion (ROM) in the sagittal plane. Pre- and postoperative neurological status was evaluated using the Japanese Orthopaedic Association (JOA) scoring system and the Nurick grading system. Mean ROM at last follow-up was not significantly different between the 2 groups (P>.05). In the hybrid group, mean JOA score and Nurick grade improved from 9.6±1.4 and 2.74±0.45 respectively, preoperatively, to 13.9±1.3 and 0.86±0.38 respectively, postoperatively. In the fixation group, mean JOA score and Nurick grade improved from 9.4±1.2 and 2.81±0.42 respectively, preoperatively, to 13.1±1.5 and 1.32±0.36 respectively, postoperatively. The JOA scores and Nurick grades at last follow-up were significantly different between the 2 groups (P<.05). In patients with preoperative cervical kyphosis, preoperative JOA score and Nurick grade were not significantly different between the 2 groups (P>.05); however, JOA scores and Nurick grades at last follow-up showed better improvement in the hybrid group than in the fixation group (P<.01). In patients with preoperative cervical lordosis, the preoperative and last follow-up JOA score and Nurick grade were not significantly different between the 2 groups (P>.05).
一种是采用颈椎前路椎间盘切除融合术（ACDF）联合节段性椎体次全切除术的混合手术，另一种是后路椎板切除术及内固定术。在2002年至2010年期间，对51例连续的四节段脊髓型颈椎病患者进行了手术治疗，其中27例接受了混合手术，24例接受了后路椎板切除术及内固定术。比较了两组的影像学数据，包括颈椎曲度和矢状面颈椎活动度（ROM）。采用日本骨科协会（JOA）评分系统和Nurick分级系统评估术前和术后的神经功能状态。两组最后随访时的平均活动度无显著差异（P>0.05）。混合手术组术前JOA平均评分和Nurick分级分别为9.6±1.4和2.74±0.且45，术后分别改善为13.9±1.3和0.8±0.38。固定手术组术前JOA平均评分和Nurick分级分别为9.4±1.2和2.81±0.42，术后分别改善为13.1±1.5和1.32±0.36。两组最后随访时的JOA评分和Nurick分级有显著差异（P<0.05）。术前存在颈椎后凸的患者，两组术前JOA评分和Nurick分级无显著差异（P>0.05）；然而，最后随访时混合手术组的JOA评分和Nurick分级改善情况优于固定手术组（P<0.01）。术前存在颈椎前凸的患者，两组术前及最后随访时的JOA评分和Nurick分级无显著差异（P>0.05）。
