| 刘 浩,刘 洋,王贝宇,丁 琛,孟 阳,王 宏,戎 鑫,洪 瑛.颈椎前路X形椎体次全切除融合内固定术治疗双节段颈椎病的疗效分析[J].中国脊柱脊髓杂志,2023,(7):592-601. |
| 颈椎前路X形椎体次全切除融合内固定术治疗双节段颈椎病的疗效分析 |
| 中文关键词: 双节段颈椎病 颈椎前路X形椎体次全切除融合固定术 颈椎前路椎体次全切除融合固定术 椎体段狭窄 |
| 中文摘要: |
| 【摘要】 目的：探讨颈椎前路X形椎体次全切除融合内固定术（anterior cervical X-shape-corpectomy and fusion，ACXF）治疗双节段颈椎病的临床疗效。方法：回顾性分析2019年1月～2020年12月间在我院骨科行ACXF治疗的双节段颈椎病患者的临床资料，并与同期行颈椎前路椎体次全切除融合固定术（anterior cervical corpectomy and fusion，ACCF）治疗的双节段颈椎病患者进行比较。收集两组患者的基线信息、手术时间、出血量及住院时间，术前和术后即刻、3个月、6个月及1年时行日本骨科学会（Japanese Orthopaedic Association，JOA）评分、疼痛视觉模拟评分（visual analogue scale，VAS），术前和术后3个月、术后6个月及术后1年行颈椎功能障碍指数（neck disability index，NDI）评估；测量ACXF组术中前方截骨距离以及两组患者术前和术后不同随访时间点的颈椎整体曲度、手术节段脊柱功能单位（functional spine unit，FSU）活动度及高度、后方减压范围、骨性椎管前后径（anterior-posterior diameter，APD）和面积（spinal canal area，SCA）等影像学参数，评估椎间融合情况，同时记录患者相关并发症。结果：共纳入46例患者，其中17例行ACXF，29例行ACCF。所有患者手术均顺利完成，ACXF组患者手术时间、出血量和住院时间分别为144.71±30.44min、109.41±55.51ml和8.35±1.46d，ACCF组分别为155.17±27.86min、126.90±51.55ml和12.03±3.34d，两组手术时间和出血量无统计学差异，ACXF组住院时间显著性少于ACCF组（P＜0.001）。两组患者术后即刻、3个月、6个月和1年时的JOA评分、VAS评分及术后3个月、6个月和1年时的NDI均较术前显著性改善，两组同时间点的JOA评分、VAS评分和NDI均无显著性差异（P＞0.05）。两组术前颈椎曲度无显著性差异，术后即刻、6个月和1年时ACXF组显著性大于ACCF组（P<0.05）。两组术后各时间点的FSU活动度与术前比较均显著性降低（P<0.01），两组同时间点比较均无显著性差异（P>0.05）。两组术后即刻FSU高度较术前显著性增加（P＜0.01），ACXF组术后3个月与术前比较有显著性差异（P＜0.05）；两组同时间点比较均无显著性差异（P>0.05）。ACXF组后方减压范围为11.66±1.31mm，显著性小于ACCF组（16.32±2.00mm）（P＜0.001）；两组术后各时间点的骨性椎管APD和SCA均术前显著性增大，ACXF组术后各时间点的骨性椎管SCA及术后1年时的APD小于同时点ACCF组（P＜0.05）。两组术后3个月、6个月、1年时的融合率均无显著性差异（P＞0.05），ACXF组内置物下沉的发生率分为别17.65%（3/17）、23.53%（4/17）及23.53%（4/17），均显著性低于同时间点ACCF组（P＜0.05）。ACXF组1例患者在术后出现轻度吞咽困难，予以保守治疗后症状明显缓解，出院时症状消失；无脑脊液漏发生。ACCF组术后出现4例吞咽困难，行康复训练，出院时症状明显好转，术后3个月随访时症状消失；3例患者发生脑脊液漏，予以延迟拔管等对症治疗，出院时治愈。结论：ACXF可以显著改善颈椎病患者的临床症状及神经功能，临床疗效与ACCF一致；且在保证充足减压范围的情况下能够进一步降低术后内置物沉降的发生，是治疗合并椎体段狭窄的双节段颈椎病的一种术式选择。 |
The clinical efficacy of anterior X-shape-corpectomy and fusion in the treatment of two-level cervical spondylosis |
| 英文关键词:Two-level cervical spondylosis Anterior X-shape-corpectomy and fusion Anterior cervical corpectomy and fusion Vertebral stenosis |
| 英文摘要: |
| 【Abstract】 Objectives: To investigate the clinical efficacy of anterior cervical X-shape-corpectomy and fusion(ACXF) in the treatment of two-level cervical spondylosis. Methods: The clinical data of two-level cervical spondylosis patients treated with ACXF in the department of Orthopedic Surgery, West China Hospital of Sichuan University from January 2019 to December 2020 were retrospectively analyzed and compared with those treated with anterior cervical corpectomy and fusion(ACCF) at the same time. The baseline data, operation time, blood loss and hospital stay of the two groups of patients were collected. The Japanese Orthopaedic Association(JOA) score and visual analogue scale(VAS) preoperatively, immediate postoperatively, at 3 and 6 months, and 1-year postoperatively, and neck disability index(NDI) preoperatively, at 3 and 6 months, and 1-year postoperatively were used to evaluate the efficacy. Anterior osteotomy distance of ACXF group during operation and imaging parameters such as cervical curvature, range of motion(ROM) and height of functional spine unit(FSU), posterior decompression range, anterior-posterior diameter(APD) of spinal canal, and spinal canal area(SCA) of the two groups during follow-up were measured to evaluate the intervertebral fusion. Meanwhile, relevant complications of patients in both groups were recorded. Results: A total of 46 patients were enrolled, including 17 in ACXF group and 29 in ACCF group. All the patients successfully underwent surgery. The operation time, blood loss, and hospital stay were 144.71±30.44min, 109.41±55.51ml, and 8.35±1.46d respectively in ACXF group, and 155.17±27.86min, 126.90±51.55ml, and 12.03±3.34d respectively in ACCF group. There was no significant difference in operation time and blood loss between the two groups, while the hospital stay in ACXF group was significantly shorter than that in ACCF group(P<0.001). The JOA score and VAS score immediate postoperatively, and at postoperative 3 and 6 months and 1 year, and NDI at postoperative 3 and 6 months and 1 year of both groups all significantly improved than those before operation, while no significant difference in JOA score, VAS score or NDI was found at the same time point between the two groups(P＞0.05). There was no significant difference in cervical curvature between the two groups before surgery, and ACXF group was significantly greater than ACCF group at immediate postoperation, 6 months, and 1 year after surgery (P<0.05). The postoperative ROM of FSU at each time point in both groups was significantly reduced than that before surgery(P<0.01), and there was no significant difference between the two groups at the same time point (P>0.05). The height of FSU immediately after surgery in both groups significantly increased than that before surgery(P<0.01), and that at postoperative 3 months in ACXF group was significantly different from that before surgery(P<0.05); There was no significant difference between the two groups at the same time point(P>0.05). The posterior decompression range of ACXF group(11.66±1.31mm) was smaller than that of ACCF group(16.32±2.00mm)(P＜0.001); The APD and SCA of spinal canal at each time point after surgery in both groups were significantly increased than those before surgery, and ACXF group was smaller in SCA at all postoperative time points and APD at 1 year after surgery than those in ACCF group at the same coressponding time points(P<0.05). There was no significant difference in the fusion rate between the two groups at 3 and 6 months and 1 year after surgery(P＞0.05). The incidence of implant subsidence of ACXF group was 17.65%(3/17), 23.53%(4/17) and 23.53%(4/17) at 3 months, 6 months and 1 year after surgery, which was significantly lower than that of ACCF group at each time point(P＜0.05). In ACXF group, 1 patient developed mild dysphagia after surgery, and symptoms significantly relieved after conservative treatment and disappeared at discharge. In ACCF group, 4 patients developed mild dysphagia after operation, and symptoms improved significantly at discharge after rehabilitation training and disappeared at 3-month follow-up; And 3 were found with cerebrospinal fluid leakage, cured at discharge after treated with delayed removal of drainage tube. Conclusions: ACXF can significantly improve the clinical symptoms and neurological function of patients with cervical spondylosis, which has a same clinical efficacy as ACCF and can further reduce the occurrence of postoperative subsidence of implant while ensuring sufficient decompression range. ACXF is an alternative surgical strategy for the treatment of two-level cervical spondylosis combined with vertebral stenosis. |
| 投稿时间：2022-06-01 修订日期：2023-04-15 |
| DOI： |
| 基金项目:四川大学华西医院卓越发展1·3·5工程项目（2021-041）；四川大学华西医院临床研究孵化项目（2022HXFH017） |
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