摘要
目的通过回顾性病例分析，评价单开门椎板成形联合椎间孔切开术（1aminoplasty with foraminotomy，LF）与前路椎间盘切除减压融合术（anterior cervical discectomy and fusion，ACDF）治疗脊髓神经根型颈椎病的临床及影像学疗效。方法自2008年1月至2010年1月，按照纳入及排除标准选取68例患者纳入研究，ACDF组33例，LF组35例，随访均超过2年。疗效评估采用日本骨科协会（Japanese Orthopedic Association，JOA）评分及改善率，影像学评估采用x线片测量颈椎曲度和颈椎活动度（rangeofmotion，ROM），末次随访时采用颈椎功能障碍指数量表neck disabilitv index，NDI）评估两组患者颈肩部疼痛的改善程度。结果ACDF组手术时间平均187min、出血量平均为127ml，与LF组（154min、235m1）比较，差异均有统计学意义（t手术时间=4．170，P=0．000；Z出血量=-6．888，P=O．ooo）。术后两组下肢感觉改善率（ACDF组64．0％、LF组66．0％）的差异有统计学意义（z=-7．512，P=O．000），而上肢运动、上肢感觉及下肢运动改善率的差异均无统计学意义。术后3个月时ACDF组出现1例植骨不融合，随访2年时3例出现邻近节段退变；而LF组未见并发症出现。末次随访时ACDF组在提物（z=-3．947，P=O．ooo）及开车（t=-7．523，P=0．ooo）方面的NDI疼痛评分低于LF组。ACDF组颈椎曲度由术前平均13．7。增加至16．2。，而LF组由14．6。降至13．3。（z=-3．374，P=O．001）。两种术式均导致术后颈椎ROM下降（ACDF组14．80、LF组16．5。），但差异有统计学意义（t=-2．167，P=0．034）。结论LF在改善长节段颈椎间盘突出所致的颈椎髓性症状及根性症状方面与ACDF的临床效果相近，但具有手术时间短、手术技术相对简单、近期并发症发生率低等优势，是治疗混合型颈椎病安全、有效的手术方式。
Objective To assess the clinical and radiologic outcomes between laminoplasty with forominotomy（LF） and anterior cervical discectomy and fusion（ACDF） in treating cervical radiculomyelopathy（CRM）. Methods Datas of 68 patients （ACDF=33, LF=35） from January 2008 to January 2010 was collected retrospectively, the follow-up is at least 2 years. The Japa- nese Orthopedic Association （JOA） score and associated recovery rate were evaluated. For radiographic evaluation, the lordotic an-gle and range of motion （ROM） at C2-C7 were investigated. The Neck Disability Index Scale（NDI） was used to evaluate the degree of patient＇ pain at the last follow-up. Results Patients＇ demographics were similar between the two groups. The differences be- tween ACDF and LF in operative time （187min VS 154min）,the blood loss （127 ml VS 235 ml） and the sensation of lower extremity （64.0% VS 66.0%） are significant（t =4.170, P= 0.000; Z=-6.888, P=O.000; Z=-7.512, P=0.000）. 1 case with failed fusion of bone graft 3 months post-operation. 3 cases of adjacent segment degenerative changes occurred at the 2nd year follow-up in ACDF group. But no such complications occurred in the EOLF group. In addition, ACDF group showed lower NDI score than LF group in extracting and amusing （Z=-3.947, P=O.O00; t=-7. 523, P=0.000）. Cervical lordosis of ACDF increased from 13.7ο to 16.2ο, while that of LF group decreased from 14.6ο to 13.3ο（Z =-3.374,P=0.001）; Both of the two groups （ACDF/LF） exhibited decreased cervi- cal ROM （14.8ο VS 16.5ο, t=-2.167, P =0.034）. Conclusion The two surgical procedures have similar clinical effects in treating multi-segmental CRM. However, the LF group demonstrated shorter operative time, fewer short-term complications, so it proved to be effective and safe surgical procedure.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2014年第8期799-806,共8页
Chinese Journal of Orthopaedics
关键词
颈椎
脊髓压迫症
神经根病
椎间孔切开术
Cervical vertebrae
Spinal cord compression
Radiculopathy
Foraminotomy
