多节段脊髓型颈椎病患者前路颈椎椎体次全切除融合术与人工椎间盘置换及椎间融合器融合术的比较
A Comparison of Anterior Cervical Corpectomy and Fusion Combined With Artificial Disc Replacement and Cage Fusion in Patients With Multilevel Cervical Spondylotic Myelopathy.
作者信息
Mao Ningfang, Wu Jinhui, Zhang Ye, Gu Xiaochuan, Wu Yungang, Lu Chunwen, Ding Muchen, Lv Runxiao, Li Ming, Shi Zhicai
机构信息
*Orthopedic Department of Changhai Hospital, Shanghai, People's Republic of China; and †Orthopedic Department of the people's Liberation Army No. 306 Hospital, Beijing, People's Republic of China.
出版信息
Spine (Phila Pa 1976). 2015 Aug 15;40(16):1277-83. doi: 10.1097/BRS.0000000000000957.
STUDY DESIGN
A retrospective study.
OBJECTIVE
The aim of this study was to compare clinical and radiological outcomes of anterior cervical corpectomy and fusion (ACCF) combined with artificial disc replacement (C-ADR) and ACCF combined with anterior cervical discectomy and fusion (ACDF) in patients with consecutive 3-level cervical spondylotic myelopathy (CSM).
SUMMARY OF BACKGROUND DATA
The optimal surgical strategy for multilevel CSM (MCSM) remains undefined. C-ADR maintains motion at the level of the surgical procedure and decreases strain on the adjacent segments. The clinical results of multilevel C-ADR have not yet been elucidated. ACCF combined with 1-level C-ADR for the treatment of consecutive 3-level CSM may be a reasonable alternative to 3-level fusion.
METHODS
We retrospectively reviewed the histories of patients who underwent surgery for consecutive 3-level CSM between C3-4 and C6-7 from June 2007 to August 2011. A total of 42 patients were divided into 2 groups. Group A (n = 19) underwent ACCF combined with 1-level C-ADR; group B (n = 23) underwent ACCF combined with 1-level ACDF. We compared perioperative parameters, clinical parameters, and radiological parameters.
RESULTS
There were no significant differences in the average age, sex ratio, the preoperative heights of the disc space or average blood loss between the 2 groups. Group A had longer operation times than group B (P < 0.05). During the follow-up period, group A showed a better Neck Dysfunction Index recovery (P < 0.05) at 24 months postoperatively, and less visual analogue scale scores at 12 and 24 months postoperatively (P < 0.05 and P < 0.001, respectively). Moreover, group A exhibited better C2-C7 range of motion recovery at 6, 12, and 24 months postoperatively (P < 0.05, respectively).
CONCLUSION
Group A was superior to Group B in terms of better Neck Dysfunction Index recovery, less intermediate term pain, and better C2-C7 ROM recovery. ACCF hybrid 1-level C-ADR may be a suitable choice for the management of 3-level CSM in appropriate patients.
LEVEL OF EVIDENCE
研究设计
一项回顾性研究。
目的
本研究旨在比较连续三节段脊髓型颈椎病（CSM）患者行颈椎前路椎体次全切除融合术（ACCF）联合人工椎间盘置换术（C-ADR）与ACCF联合颈椎前路椎间盘切除融合术（ACDF）的临床和影像学结果。
背景资料总结
多节段CSM（MCSM）的最佳手术策略仍不明确。C-ADR可保持手术节段的活动度，并减少相邻节段的应力。多节段C-ADR的临床结果尚未阐明。ACCF联合单节段C-ADR治疗连续三节段CSM可能是三节段融合术的合理替代方案。
方法
我们回顾性分析了2007年6月至2011年8月间接受连续三节段CSM手术（C3-4至C6-7）患者的病史。共42例患者分为2组。A组（n = 19）行ACCF联合单节段C-ADR；B组（n = 23）行ACCF联合单节段ACDF。我们比较了围手术期参数、临床参数和影像学参数。
结果
两组患者的平均年龄、性别比例、术前椎间隙高度或平均失血量无显著差异。A组手术时间比B组长（P < 0.05）。随访期间，A组术后24个月颈部功能障碍指数恢复情况更好（P < 0.05），术后12个月和24个月视觉模拟评分更低（分别为P < 0.05和P < 0.001）。此外，A组术后6个月、12个月和24个月C2-C7活动度恢复情况更好（分别为P < 0.05）。
结论
A组在颈部功能障碍指数恢复更好、中期疼痛更少以及C2-C7活动度恢复更好方面优于B组。ACCF联合单节段C-ADR可能是合适患者三节段CSM治疗的合适选择。
证据级别
3级。
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