[1]李亚伟,梅伟,张振辉,等.显微镜辅助下前路颈椎间盘切除融合术治疗骨性压迫致神经根型颈椎病的临床研究[J].中医正骨,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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显微镜辅助下前路颈椎间盘切除融合术治疗骨性压迫致神经根型颈椎病的临床研究()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第34卷
期数:
2022年10期
页码:
18-26
栏目:
临床研究
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:
李亚伟1梅伟2张振辉2李文祥3
(1.河南中医药大学第二临床医学院,河南 郑州 450002; 2.郑州市骨科医院,河南 郑州 450052; 3.周口骨科医院,河南 周口 466000)
Author(s):
LI Yawei1MEI Wei2ZHANG Zhenhui2LI 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
关键词:
颈椎病 脊柱骨赘病 椎间盘切除术 脊柱融合术 手术显微镜 临床试验
Keywords:
cervical spondylosis spinal osteophytosis diskectomy spinal fusion operating microscope clinical trial
摘要:
目的:观察显微镜辅助下前路颈椎间盘切除融合术(anterior cervical discectomy and fusion,ACDF)治疗骨性压迫致神经根型颈椎病的临床疗效和安全性。方法:回顾性分析46例骨性压迫致神经根型颈椎病患者的病例资料,其中采用显微镜辅助下ACDF(术中行精细化减压)治疗22例(显微镜辅助下ACDF组),采用前路颈椎体次全切除融合术(anterior cervical corpectomy and fusion,ACCF)治疗24例(ACCF组)。比较2组患者的术中出血量、手术时间、颈椎疼痛视觉模拟量表(visual analogue scale,VAS)评分、日本骨科学会(Japanese Orthopaedic Association,JOA)脊髓型颈椎病评分、椎间融合率及并发症发生率。结果:①一般结果。显微镜辅助下ACDF组患者术中出血量少于ACCF组[(41.18±11.00)mL,(91.42±21.31)mL,t=-9.906,P=0.000],手术时间短于ACCF组[(59.59±8.71)min,(79.79±17.45)min,t=-4.896,P=0.000]。②颈椎疼痛VAS评分。时间因素和分组因素存在交互效应(F=3.689,P=0.036); 2组患者的颈椎疼痛VAS评分总体比较,组间差异有统计学意义,即存在分组效应(F=4.564,P=0.038); 手术前后不同时间点颈椎疼痛VAS评分的差异有统计学意义,即存在时间效应(F=278.765,P=0.000); 2组患者颈椎疼痛VAS评分随时间变化均呈下降趋势,但2组的下降趋势不完全一致(F=165.747,P=0.000; F=210.692,P=0.000); 术前、术后1个月,2组患者颈椎疼痛VAS评分比较,组间差异均无统计学意义[(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]; 术后1周,显微镜辅助下ACDF组患者颈椎疼痛VAS评分低于ACCF组[(2.05±0.70)分,(2.75±0.75)分,t=-3.222,P=0.002)]。③JOA脊髓型颈椎病评分。时间因素和分组因素存在交互效应(F=3.863,P=0.021); 2组患者的JOA脊髓型颈椎病评分总体比较,组间差异有统计学意义,即存在分组效应(F=6.276,P=0.016); 手术前后不同时间点JOA脊髓型颈椎病评分的差异有统计学意义,即存在时间效应(F=517.958,P=0.000); 2组患者JOA脊髓型颈椎病评分随时间变化均呈上升趋势,但2组的上升趋势不完全一致(F=154.860,P=0.000; F=179.492,P=0.000); 术前、术后6个月,2组患者JOA脊髓型颈椎病评分比较,组间差异均无统计学意义[(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]; 术后1个月、术后3个月,显微镜辅助下ACDF组患者JOA脊髓型颈椎病评分均低于ACCF组[(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椎间融合率。术后3个月,显微镜辅助下ACDF组椎间未融合2例,ACCF组椎间未融合6例; 术后6个月,显微镜辅助下ACDF组椎间全部融合,ACCF组椎间未融合3例; 术后1年,2组患者椎间全部融合。术后3个月、术后6个月及术后1年,2组患者椎间融合率比较,组间差异均无统计学意义(χ2=2.022,P=0.155; χ2=2.942,P=0.086; P=1.000)。⑤并发症发生率。显微镜辅助下ACDF组术后出现声音嘶哑1例、C5神经根麻痹1例,ACCF组术后出现硬脊膜外血肿1例、吞咽困难1例。硬脊膜外血肿患者经手术清创后血肿消除,无神经并发症发生; 其余患者经口服药物、理疗等治疗后均好转。2组患者并发症发生率比较,差异无统计学意义(χ2=0.008,P=0.927)。结论:采用显微镜辅助下ACDF治疗骨性压迫致神经根型颈椎病,与ACCF比较,术中出血量少、手术时间短、颈椎疼痛缓解快,但颈椎功能恢复慢,二者在椎间融合及安全性方面均相当。
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.

参考文献/References:

[1] 中华外科杂志编辑部.颈椎病的分型、诊断及非手术治疗专家共识(2018)[J].中华外科杂志,2018,56(6):401-402.
[2] NAKASHIMA H,KANEMURA T,KANBARA S,et al.What are the important predictors of postoperative functional recovery in patients with cervical OPLL?Results of a multivariate analysis[J].Global Spine J,2019,9(3):315-320.
[3] 潘冬生,宋振全,赵明光,等.术中CT辅助下颈椎前路手术骨减压效果的评估[J].中华神经外科杂志,2017,33(2):124-127.
[4] HANKINSON H L,WILSON C B.Use of the operating microscope in anterior cervical discectomy without fusion[J].J Neurosurg,1975,43(4):452-456.
[5] 刘云鹏,刘沂.骨与关节损伤和疾病的诊断分类及功能评定标准[M].北京:清华大学出版社,2002:243-244.
[6] ROSE J S,MOORE K R,SHAH L M,et al.脊柱诊断影像学[M].赵斌,王翠艳,译.济南:山东科学技术出版社,2018:1038-1041.
[7] CLIFTON W,WILLIAMS D,PICHELMANN M.How I do it:total uncinatectomy during anterior diskectomy and fusion for cervical radiculopathy caused by uncovertebral joint hypertrophy[J].Acta Neurochir(Wien),2019,161(10):2229-2232.
[8] LEE D H,CHO J H,BAIK J M,et al.Does additional uncinate resection increase pseudarthrosis following anterior cervical discectomy and fusion?[J].Spine(Phila Pa 1976),2018,43(2):97-104.
[9] 余文超,袁文,陈华江,等.脊髓型颈椎病颈前路手术对术后颈椎矢状位平衡参数的影响[J].中华骨科杂志,2018,38(21):1285-1292.
[10] 汪文龙,海涌,关立,等.前路或后路手术治疗颈椎后纵韧带骨化症的中期疗效观察[J].中国脊柱脊髓杂志,2016,26(7):577-584.
[11] CHEN Z H,LIU B,DONG J W,et al.Comparison of ante-rior corpectomy and fusion versus laminoplasty for the treatment of cervical ossification of posterior longitudinal ligament:a meta analysis[J].Neurosurg Focus,2016,40(6):E8.
[12] 伍搏宇,徐峰,康辉,等.显微镜下ACDF与常规ACDF治疗脊髓型颈椎病的对比分析[J].中国临床神经外科杂志,2019,24(5):272-275.
[13] 罗海涛,程祖珏,吕世刚,等.显微镜辅助与传统直视下颈椎前路减压治疗颈椎病的Meta分析[J].中国组织工程研究,2020,24(9):1464-1470.
[14] 马远,叶向阳,王华磊,等.显微镜辅助下颈前路椎间盘切除植骨融合术治疗孤立型颈椎后纵韧带骨化症[J].中医正骨,2020,32(2):57-60.
[15] 王洪伟,高飞,段洪凯,等.显微镜辅助颈前路减压自锁式颈椎融合器治疗颈椎病20例[J].中国微创外科杂志,2019,19(5):455-457.
[16] HANNALLAH D,LEE J,KHAN M,et al.Cerebrospinal fluid leaks following cervical spine surgery[J].J Bone Joint Surg Am,2008,90(5):1101-1105.
[17] TABARAEE E,AHN J,BOHL D D,et al.Comparison of surgical outcomes,narcotics utilization,and costs after an anterior cervical discectomy and fusion:stand-alone cage versus anterior plating[J].Clin Spine Surg,2017,30(9):E1201-E1205.
[18] BRUNEAU M,CORNELIUS J F,GEORGE B.Multilevel oblique corpectomies:surgical indications and technique[J].Neurosurgery,2007,61(3 Suppl):106-112.
[19] 郭玮,戴驭虎,彭新生.显微镜下前路手术治疗颈椎后纵韧带骨化症的经验[J].中华显微外科杂志,2021,44(5):572-573.
[20] SPETZLER R F,ROSKI R A,SELMAN W R.The microscope in anterior cervical spine surgery[J].Clin Orthop Relat Res,1982(168):17-23.
[21] 王俊,廖中东,万里,等.显微镜辅助下颈前路减压植骨融合术治疗颈椎病的疗效观察[J].颈腰痛杂志,2018,39(5):597-599.

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通讯作者:梅伟 E-mail:13613711661@163.com
更新日期/Last Update: 1900-01-01