三种颈前路减压术式的早期疗效比较

发布时间：2018-05-04 02:47

本文选题：颈椎病 + 颈椎前路手术　；参考：《浙江大学》2015年博士论文

【摘要】：研究目的：通过临床观察和随访,多个指标综合评估颈椎前路椎体次全切除减压融合术(anterior cervical corpectomy with fusion, ACCF)、应用传统钛板联合融合器进行颈椎前路椎间盘切除减压融合术(anterior cervical discectomy with fusion, ACDF)和Zero-P椎间融合器进行颈椎前路椎间盘切除减压融合术(ACDF)这三种颈前路减压术后患者颈椎功能改善情况等。探讨三种颈前路减压术式的早期临床疗效,以期找到合适治疗颈椎病的手术方式。研究方法：本研究回顾性地分析了2012年1月至2014年9月期间浙江大学医学院附属邵逸夫医院收治的82例行颈前路减压术的颈椎病患者。按所选用的颈前路减压术式,分成A组为应用Zero-P椎间融合器行ACDF术38例；B组为传统钛板联合融合器进行ACDF计25例；C组为应用传统钛板联合钛网进行ACCF共19例。通过比较各组患者的手术时间以及术前、术后和末次随访时疼痛视觉模拟评分(visual agalogue scale, VAS;10分法)、日本骨科学会(Japanese Orthopedic Association,JOA)17分评分法及椎间隙高度和Cobb角等影像学观察指标,分析三种颈前路减压术式的临床疗效。研究结果： C组术中平均出血量(142.1±103.1ml)相较A组(64.7±56.0m1)及B组(60.4±34.2m1)多,且有统计学意义。三组间手术时间、住院时间比较并无统计学差异。三组患者末次随访JOA评分、VAS评分较术前均有提高(P0.05)；但三组间末次随访的平均JOA改善率间比较差异无统计学意义。A组患者末次随访椎间隙高度及融合节段Cobb角较术前有增加(P0.05)。各组患者间术后1天、末次随访的C2-7节段Cobb角无差异。研究结论：应用Zero-P椎间融合器进行ACDF、应用传统钛板联合融合器进行ACDF和应用传统钛板联合钛网进行ACCF这三种颈前路减压术式其术后临床疗效确切。但三种术式的临床疗效并无显著性差异。应用传统钛板联合钛网进行ACCF相较另两种颈前路减压术式在术中出血量多。应用Zero-P椎间融合器进行ACDF相较另两种颈前路减压术式在末次随访时影像学上颈椎生理曲度得到明显改善并维持,但是否可明确减少术后相邻椎体节段的退变发生率仍需进行更长时间的随访调查论证。
[Abstract]:Objectives of the study: Through clinical observation and follow-up, Multiple indexes were used to evaluate anterior cervical corpectomy with fusion, ACCF for anterior cervical corpectomy with fusion, fusion. Anterior cervical discectomy with fusion, ACDF) and Zero-P intervertebral fusion cage were performed with conventional titanium plate combined with cage for anterior discectomy and decompression fusion of anterior cervical vertebrae. The patients with anterior cervical decompression and fusion were treated with anterior cervical discectomy and decompression and fusion (ACDF). To explore the early clinical effect of three anterior cervical decompression methods in order to find suitable surgical treatment for cervical spondylosis. Research methods: From January 2012 to September 2014, 82 patients with cervical spondylosis treated with anterior cervical decompression were analyzed retrospectively. According to the method of anterior cervical decompression, the patients in group A were divided into two groups: group A (n = 38) underwent ACDF with Zero-P intervertebral fusion cage, group B (n = 25) ACDF with conventional titanium plate and cage, group C (n = 25) with traditional titanium plate and titanium mesh for ACCF (n = 19). By comparing the time of operation, preoperative, postoperative and follow-up visual analogue score (VAS) with visual agalogue scale, VAS; 10 method, Japanese Orthopedic Association (JOA17) score, intervertebral space height and Cobb angle, and so on, the patients in each group were assessed with visual analogue score (VAS), visual analogue score (VAS) and Japanese Orthopedic Association (JOAA). To analyze the clinical effect of three kinds of anterior cervical decompression. Results of the study: The average intraoperative bleeding volume in group C was 142.1 卤103.1 ml, which was significantly higher than that in group A (64.7 卤56.0 ml) and group B (60.4 卤34.2 ml). There was no significant difference in operation time and hospital stay among the three groups. However, there was no significant difference in the average improvement rate of JOA between the three groups. The height of intervertebral space and the Cobb angle of fusion segment in the last follow-up of group A were significantly higher than those before operation (P 0.05). There was no difference in the Cobb angle of C 2-7 segment between the groups 1 day after operation and the last follow-up. Conclusion: using Zero-P interbody fusion cage, traditional titanium plate combined with cage for ACDF and traditional titanium plate combined with titanium mesh for ACCF are the three kinds of anterior cervical decompression methods. However, there was no significant difference in clinical efficacy among the three types of operations. Compared with the other two anterior cervical decompression methods, traditional titanium plate combined with titanium mesh had more blood loss during operation than other two anterior cervical decompression methods. Compared with the other two anterior cervical decompression methods, Zero-P interbody fusion cage was used to perform ACDF in the last follow-up. However, a longer follow-up study is needed to determine whether the incidence of degeneration in adjacent vertebral segments can be clearly reduced.
【学位授予单位】：浙江大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R687.3

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