Department of Orthopedics, West China Hospital, Sichuan University, 37# Guoxue Lane, Chengdu, 610041, Sichuan Province, China.
West China School of Nursing, Sichuan University, Chengdu, 610041, Sichuan Province, China.
BMC Surg. 2022 May 14;22(1):179. doi: 10.1186/s12893-022-01627-7.
According to the different numbers and locations of cervical disc arthroplasty (CDA) and anterior cervical discectomy and fusion (ACDF), three-level hybrid surgery (HS) has many constructs. The purpose of the present study was to introduce a classification system for three-level HS and compare the two types with each other and with ACDF.
A retrospective study was conducted involving patients with three-level cervical degenerative disc disease (CDDD) who underwent ACDF or HS in our hospital between June 2012 and May 2019. According to the different numbers and locations of ACDFs and CDAs, we classified the three-level HS into two types (type I: one-level CDA and two-level ACDF, and type II: two-level CDA and one-level ACDF). The differences of clinical and radiological outcomes were compared with each other and with three-level ACDF.
A total of 108 patients were analyzed. The Neck Disability Index (NDI) of the ACDF group at 3 months postoperatively was significantly higher than that in the type I and type II groups (p < 0.05). The cervical lordosis was significantly lower in the ACDF group than that in the type I and II groups at 3 days, 6, 12 months postoperatively and the final follow-up (p < 0.05). The range of motion (ROM) of the total cervical spine decreased significantly in all three groups at 3, 6, and 12 months postoperatively and at the final follow-up (p < 0.05). The ACDF group was observed with the most severe loss of ROM of the total cervical spine, followed by the type I group. The type II group could preserve the most ROM of the total cervical spine. The ROM of adjacent segments increased most in the ACDF group, followed by the type I group.
Compared with ACDF, three-level HS may yield a faster recovery rate and superior radiological outcomes, such as a superiority in maintaining the cervical curvature and ROM of the total cervical spine and a smaller increase in the ROM of adjacent segments. The advantages were most remarkable in the type II group.
根据颈椎间盘置换术（CDA）和前路颈椎间盘切除融合术（ACDF）的数量和位置的不同，三平面杂交手术（HS）有多种结构。本研究的目的是介绍一种三平面 HS 的分类系统，并将其与其他两种方法（ACDF）进行比较。
对 2012 年 6 月至 2019 年 5 月在我院行三平面颈椎退行性椎间盘疾病（CDDD）的患者进行回顾性研究，根据 ACDF 和 CDA 的数量和位置的不同，将三平面 HS 分为两型（I 型：单节段 CDA 和两节段 ACDF，II 型：两节段 CDA 和一节段 ACDF）。比较了两种方法之间的临床和影像学结果，并与三平面 ACDF 进行了比较。
共分析了 108 例患者。ACDF 组术后 3 个月的颈部残疾指数（NDI）明显高于 I 型和 II 型组（p<0.05）。术后 3 天、6 个月、12 个月和末次随访时，ACDF 组颈椎前凸较 I 型和 II 型组明显降低（p<0.05）。所有三组患者术后 3 个月、6 个月和 12 个月及末次随访时，总颈椎活动度（ROM）均显著降低（p<0.05）。ACDF 组总颈椎 ROM 丢失最为严重，其次是 I 型组。II 型组能保持总颈椎 ROM 最多。ACDF 组相邻节段 ROM 增加最多，其次是 I 型组。
与 ACDF 相比，三平面 HS 可能具有更快的恢复速度和更好的影像学结果，如在维持颈椎曲度和总颈椎 ROM 方面具有优势，以及在相邻节段 ROM 增加方面具有较小的优势。II 型组的优势最为明显。
