显微镜辅助下经颈椎前路椎间盘切除融合术治疗脊髓型颈椎病的疗效分析

doi:10.3760/cma.j.cn101202-20190905-00279

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摘要目的探讨在显微镜辅助下经颈椎前路椎间盘切除融合术(ACDF)治疗脊髓型颈椎病(CSM)的临床疗效。方法回顾性分析2014年1月—2018年6月四川省广安市广安区人民医院骨科44例行ACDF的CSM患者的临床资料,其中男24例、女20例,年龄34~69(51.4±10.2)岁。按照手术方式不同分为:传统ACDF组20例,31个节段;显微ACDF组24例,38个节段。比较两组患者的基线资料、住院时间、手术时间、术中出血量、术后引流量,术后即刻以及随访3、6、12个月时的日本骨科学会颈椎病疗效评定标准(JOA)评分、颈椎功能障碍指数(NDI)评分、疼痛视觉模拟评分(VAS)、椎间隙高度、颈椎Cobb角、临床疗效和植骨融合情况。结果两组患者的基线资料比较差异均无统计学意义(P值均＞0.05)。显微ACDF组和传统ACDF组手术时间分别为(91.2±8.2)、(85.1±7.8)min,出血量分别为(50.1±10.5)、(80.2±11.2)mL,引流量分别为(20.2±13.7)、(30.5±11.5)mL,差异均有统计学意义(t=-2.512、9.186、2.688, P值均＜0.05);两组患者住院时间差异无统计学意义(P＞0.05)。两组患者术后即刻及随访3、6、12个月的JOA 评分、NDI评分、VAS、椎间隙高度和颈椎Cobb角均较术前改善,差异均有统计学意义(F=60.435、419.723、21.037, P值均＜0.05),但两组间差异无统计学意义(P值均＞0.05)。术后随访12个月,传统ACDF组和显微ACDF组临床疗效评价优良以上的占比分别为95.00%(19/20)和95.83%(23/24)。末次随访两组患者植骨均融合,无明显并发症。结论传统ACDF和在显微镜辅助下ACDF均能有效治疗CSM,但是同传统ACDF相比,显微镜辅助下ACDF的优势更明显,其手术视野清晰,术中止血彻底,术中出血量和术后引流量低。

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	杨新华
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关键词 ：颈椎病, 脊髓型颈椎病, 显微镜, 颈前路椎间盘切除植骨融合术

Key words： Cervical spondylosis Cervical spondylotic myelopathy Microscope Anterior cervical discectomy and fusion

收稿日期: 2019-09-05

通讯作者: 刘鹏,Email:liupengd@163.com

引用本文:

杨新华, 刘鹏, 张良, 朱军, 兰宗江. 显微镜辅助下经颈椎前路椎间盘切除融合术治疗脊髓型颈椎病的疗效分析[J]. 中华解剖与临床杂志, 2020, 25(5): 560-564.
Yang Xinhua, Liu Peng, Zhang Liang, Zhu Jun, Lan Zongjiang. The clinical effect of microscopic-assisted anterior cervical discectomy and fusion in the treatment of cervical spondylotic myelopathy. Chinese Journal of Anatomy and Clinics, 2020, 25(5): 560-564.

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http://www.cjac.com.cn/CN/10.3760/cma.j.cn101202-20190905-00279 或 http://www.cjac.com.cn/CN/Y2020/V25/I5/560

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