Huang Kangkang, Liu Hao, Wang Beiyu, Wu Tingkui, Ding Chen, He Junbo, Meng Yang, Wang Han, Hong Ying
Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Department of Operation Room, Sichuan University, West China Hospital, Chengdu, Sichuan, China.
J Orthop Res. 2023 May;41(5):1105-1114. doi: 10.1002/jor.25436. Epub 2022 Sep 13.
To compare the differences among constructs with one-level cervical disc arthroplasty (CDA) and two-level anterior cervical discectomy and fusion (ACDF). A retrospective study was conducted involving patients who underwent one-level CDA and two-level ACDF between June 2012 and July 2020. According to the different locations of CDA and ACDF, we divided the constructs into three types: type Ⅰa: CDA-ACDF-ACDF; type Ⅰb: ACDF-CDA-ACDF; type Ⅰc: ACDF-ACDF-CDA. The differences of clinical and radiological outcomes were evaluated. Fifty-three patients were included with 29 in type Ⅰa group, 11 in type Ⅰb group, and 13 in type Ⅰc group. After surgery, all groups showed significant improvement in apanese Orthopedic Association, Neck Disability Index, and Visual Analog Scale scores (p < 0.001). Range of motion (ROM) of the total cervical spine in type Ⅰc group decreased significantly compared with those in type Ⅰa and type Ⅰb groups (p < 0.05). No significant differences in ROM of the arthroplasty segment and the variations in ROM of the superior adjacent segment were observed among the three groups. The fusion rates of the superior ACDF segments were significantly higher at 6 and 12 months postoperatively than those of the inferior ACDF segments (p < 0.05). The clinical outcomes were similar among constructs concerning different locations of CDA and ACDF in three-level hybrid surgery. ROM of the cervical spine in type Ⅰc group decreased significantly compared with that in type Ⅰa and type Ⅰb groups. The fusion rates of superior ACDF segments were higher at early time points after surgery than those of inferior ACDF segments.
比较单节段颈椎间盘置换术（CDA）和双节段颈椎前路椎间盘切除融合术（ACDF）在不同组合方式下的差异。进行了一项回顾性研究，纳入2012年6月至2020年7月期间接受单节段CDA和双节段ACDF手术的患者。根据CDA和ACDF的不同位置，将组合方式分为三种类型：Ⅰa型：CDA - ACDF - ACDF；Ⅰb型：ACDF - CDA - ACDF；Ⅰc型：ACDF - ACDF - CDA。评估临床和影像学结果的差异。共纳入53例患者，其中Ⅰa组29例，Ⅰb组11例，Ⅰc组13例。术后，所有组的日本骨科协会评分、颈部功能障碍指数和视觉模拟量表评分均有显著改善（p < 0.001）。与Ⅰa组和Ⅰb组相比，Ⅰc组全颈椎活动度（ROM）显著降低（p < 0.05）。三组间置换节段的ROM及上位相邻节段ROM变化无显著差异。术后6个月和12个月时，上位ACDF节段的融合率显著高于下位ACDF节段（p < 0.05）。在三级混合手术中，不同CDA和ACDF位置组合的临床结果相似。与Ⅰa组和Ⅰb组相比，Ⅰc组颈椎ROM显著降低。术后早期，上位ACDF节段的融合率高于下位ACDF节段。
