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[1]李亞偉,梅偉,張振輝,等.顯微鏡輔助下前路頸椎間盤切除融合術(shù)治療骨性壓迫致神經(jīng)根型頸椎病的臨床研究[J].中醫(yī)正骨,2022,34(10):18-26.
　LI Yawei,MEI Wei,ZHANG Zhenhui,et al.A clinical study of microscope-assisted anterior cervical discectomy and fusion for treatment of cervical spondylotic radiculopathy caused by bone compression[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2022,34(10):18-26.
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顯微鏡輔助下前路頸椎間盤切除融合術(shù)治療骨性壓迫致神經(jīng)根型頸椎病的臨床研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第34卷
期數(shù):
2022年10期
頁碼:
18-26
欄目:
臨床研究
出版日期:
2022-10-20

文章信息/Info

Title:
A clinical study of microscope-assisted anterior cervical discectomy and fusion for treatment of cervical spondylotic radiculopathy caused by bone compression
作者:
李亞偉1; 梅偉2; 張振輝2; 李文祥3
(1.河南中醫(yī)藥大學(xué)第二臨床醫(yī)學(xué)院,河南 鄭州 450002; 2.鄭州市骨科醫(yī)院,河南 鄭州 450052; 3.周口骨科醫(yī)院,河南 周口 466000)
Author(s):
LI Yawei1; MEI Wei2; ZHANG Zhenhui2; LI Wenxiang3
1.The Second Clinical Medical College of Henan University of Chinese Medicine,Zhengzhou 450002,Henan,China 2.Zhengzhou Orthopedics Hospital,Zhengzhou 450052,Henan,China 3.Zhoukou Orthopaedic Hospital,Zhoukou 466000,Henan,China
關(guān)鍵詞:
頸椎病;  脊柱骨贅病;  椎間盤切除術(shù);  脊柱融合術(shù);  手術(shù)顯微鏡;  臨床試驗
Keywords:
cervical spondylosis;  spinal osteophytosis;  diskectomy;  spinal fusion;  operating microscope;  clinical trial
摘要:
目的:觀察顯微鏡輔助下前路頸椎間盤切除融合術(shù)(anterior cervical discectomy and fusion,ACDF)治療骨性壓迫致神經(jīng)根型頸椎病的臨床療效和安全性。方法:回顧性分析46例骨性壓迫致神經(jīng)根型頸椎病患者的病例資料,其中采用顯微鏡輔助下ACDF(術(shù)中行精細(xì)化減壓)治療22例(顯微鏡輔助下ACDF組),采用前路頸椎體次全切除融合術(shù)(anterior cervical corpectomy and fusion,ACCF)治療24例(ACCF組)。比較2組患者的術(shù)中出血量、手術(shù)時間、頸椎疼痛視覺模擬量表(visual analogue scale,VAS)評分、日本骨科學(xué)會(Japanese Orthopaedic Association,JOA)脊髓型頸椎病評分、椎間融合率及并發(fā)癥發(fā)生率。結(jié)果:①一般結(jié)果。顯微鏡輔助下ACDF組患者術(shù)中出血量少于ACCF組[(41.18±11.00)mL,(91.42±21.31)mL,t=-9.906,P=0.000],手術(shù)時間短于ACCF組[(59.59±8.71)min,(79.79±17.45)min,t=-4.896,P=0.000]。②頸椎疼痛VAS評分。時間因素和分組因素存在交互效應(yīng)(F=3.689,P=0.036); 2組患者的頸椎疼痛VAS評分總體比較,組間差異有統(tǒng)計學(xué)意義,即存在分組效應(yīng)(F=4.564,P=0.038); 手術(shù)前后不同時間點頸椎疼痛VAS評分的差異有統(tǒng)計學(xué)意義,即存在時間效應(yīng)(F=278.765,P=0.000); 2組患者頸椎疼痛VAS評分隨時間變化均呈下降趨勢,但2組的下降趨勢不完全一致(F=165.747,P=0.000; F=210.692,P=0.000); 術(shù)前、術(shù)后1個月,2組患者頸椎疼痛VAS評分比較,組間差異均無統(tǒng)計學(xué)意義[(3.95±0.79)分,(4.00±0.85)分,t=-0.208,P=0.836;(0.75±0.44)分,(0.80±0.40)分,t=-0.474,P=0.638]; 術(shù)后1周,顯微鏡輔助下ACDF組患者頸椎疼痛VAS評分低于ACCF組[(2.05±0.70)分,(2.75±0.75)分,t=-3.222,P=0.002)]。③JOA脊髓型頸椎病評分。時間因素和分組因素存在交互效應(yīng)(F=3.863,P=0.021); 2組患者的JOA脊髓型頸椎病評分總體比較,組間差異有統(tǒng)計學(xué)意義,即存在分組效應(yīng)(F=6.276,P=0.016); 手術(shù)前后不同時間點JOA脊髓型頸椎病評分的差異有統(tǒng)計學(xué)意義,即存在時間效應(yīng)(F=517.958,P=0.000); 2組患者JOA脊髓型頸椎病評分隨時間變化均呈上升趨勢,但2組的上升趨勢不完全一致(F=154.860,P=0.000; F=179.492,P=0.000); 術(shù)前、術(shù)后6個月,2組患者JOA脊髓型頸椎病評分比較,組間差異均無統(tǒng)計學(xué)意義[(7.73±1.08)分,(8.04±1.08)分,t=-0.986,P=0.329;(14.55±1.10)分,(14.63±1.10)分,t=-0.245,P=0.807]; 術(shù)后1個月、術(shù)后3個月,顯微鏡輔助下ACDF組患者JOA脊髓型頸椎病評分均低于ACCF組[(9.86±1.04)分,(11.00±1.10)分,t=-3.590,P=0.001;(11.64±1.05)分,(12.50±1.14)分,t=-2.664,P=0.011]。④椎間融合率。術(shù)后3個月,顯微鏡輔助下ACDF組椎間未融合2例,ACCF組椎間未融合6例; 術(shù)后6個月,顯微鏡輔助下ACDF組椎間全部融合,ACCF組椎間未融合3例; 術(shù)后1年,2組患者椎間全部融合。術(shù)后3個月、術(shù)后6個月及術(shù)后1年,2組患者椎間融合率比較,組間差異均無統(tǒng)計學(xué)意義(χ2=2.022,P=0.155; χ2=2.942,P=0.086; P=1.000)。⑤并發(fā)癥發(fā)生率。顯微鏡輔助下ACDF組術(shù)后出現(xiàn)聲音嘶啞1例、C5神經(jīng)根麻痹1例,ACCF組術(shù)后出現(xiàn)硬脊膜外血腫1例、吞咽困難1例。硬脊膜外血腫患者經(jīng)手術(shù)清創(chuàng)后血腫消除,無神經(jīng)并發(fā)癥發(fā)生; 其余患者經(jīng)口服藥物、理療等治療后均好轉(zhuǎn)。2組患者并發(fā)癥發(fā)生率比較,差異無統(tǒng)計學(xué)意義(χ2=0.008,P=0.927)。結(jié)論:采用顯微鏡輔助下ACDF治療骨性壓迫致神經(jīng)根型頸椎病,與ACCF比較,術(shù)中出血量少、手術(shù)時間短、頸椎疼痛緩解快,但頸椎功能恢復(fù)慢,二者在椎間融合及安全性方面均相當(dāng)。
Abstract:
Objective:To investigate the clinical efficacy and safety of microscope-assisted anterior cervical discectomy and fusion(ACDF)for treatment of cervical spondylotic radiculopathy(CSR)caused by bone compression.Methods:The medical records of 46 patients with CSR caused by bone compression were analyzed retrospectively.Twenty-two patients were treated with microscope-assisted ACDF(microscope-assisted ACDF group)and 24 ones with anterior cervical corpectomy and fusion(ACCF)(ACCF group).The intraoperative blood loss,operative time,cervical pain visual analogue scale(VAS)score,Japanese Orthopaedic Association(JOA)score for assessing cervical spondylotic myelopathy(CSM),intervertebral fusion rate and complications were compared between the 2 groups.Results:①The intraoperative blood loss was less and the operative time was shorter in microscope-assisted ACDF group compared to ACCF group(41.18±11.00 vs 91.42±21.31 mL,t=-9.906,P=0.000; 59.59±8.71 vs 79.79±17.45 minutes,t=-4.896,P=0.000).②There was interaction between time factor and group factor in cervical pain VAS score(F=3.689,P=0.036).There was statistical difference in cervical pain VAS scores between the 2 groups in general,in other words,there was group effect(F=4.564,P=0.038).There was statistical difference in cervical pain VAS scores between different timepoints before and after the surgery,in other words,there was time effect(F=278.765,P=0.000).The cervical pain VAS scores presented a downward trend over time in the 2 groups,while the 2 groups were inconsistent with each other in the variation tendency(F=165.747,P=0.000; F=210.692,P=0.000).There was no statistical difference in cervical pain VAS scores between the 2 groups before the surgery and at postsurgical month 1(3.95±0.79 vs 4.00±0.85 points,t=-0.208,P=0.836; 0.75±0.44 vs 0.80±0.40 points,t=-0.474,P=0.638),while the cervical pain VAS scores decreased in microscope-assisted ACDF group compared to ACCF group at postsurgical week 1(2.05±0.70 vs 2.75±0.75 points,t=-3.222,P=0.002).③There was interaction between time factor and group factor in JOA CSM score(F=3.863,P=0.021).The difference was statistically significant in JOA CSM scores between the 2 groups in general,in other words,there was group effect(F=6.276,P=0.016),furthermore,the difference was statistically significant between the different timepoints before and after the surgery,in other words,there was time effect(F=517.958,P=0.000).The JOA CSM scores presented a upward trend over time in the 2 groups,while the 2 groups were inconsistent with each other in the variation tendency(F=154.860,P=0.000; F=179.492,P=0.000).There was no statistical difference in JOA CSM scores between the 2 groups before the surgery and at postsurgical month 6(7.73±1.08 vs 8.04±1.08 points,t=-0.986,P=0.329; 14.55±1.10 vs 14.63±1.10 points,t=-0.245,P=0.807),while the JOA CSM scores decreased in microscope-assisted ACDF group compared to ACCF group at postsurgical month 1 and 3(9.86±1.04 vs 11.00±1.10 points,t=-3.590,P=0.001; 11.64±1.05 vs 12.50±1.14 points,t=-2.664,P=0.011).④At postsurgical month 3,failed interbody fusion was found in 2 patients in microscope-assisted ACDF group and 6 patients in ACCF group.At postsurgical month 6,interbody fusion was found in all patients in microscope-assisted ACDF group and failed interbody fusion was found in 3 patients in ACCF group.At postsurgical month 12,interbody fusion was found in all patients in the 2 groups.There was no statistical difference in intervertebral fusion rate between the 2 groups at postsurgical month 3,6 and 12(χ2=2.022,P=0.155; χ2=2.942,P=0.086; P=1.000).⑤After the surgery,the hoarse voice(1 case)and C5 nerve root palsy(1 case)were found in microscope-assisted ACDF group,while the spinal epidural hematoma(1 case)and dysphagia(1 case)were found in ACCF group.The spinal epidural hematoma was removed after surgical debridement,and no neurological complications occurred.The other complications,such as hoarse voice,C5 nerve root palsy and dysphagia,were improved after treatment with medication and physiotherapy.There was no statistical difference in complication incidence between the 2 groups(χ2=0.008,P=0.927).Conclusion:The microscope-assisted ACDF displays the advantages of less intraoperative blood loss,shorter operative time and faster cervical pain relief,but the disadvantage of slower cervical function recovery compared to ACCF in treatment of CSR caused by bone compression,whereas the two therapies are similar to each other in intervertebral fusion and safety.

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備注/Memo

備注/Memo:
通訊作者:梅偉 E-mail:[email protected]
更新日期/Last Update: 1900-01-01