| 沈宝良,沈洪兴,陈智,劳立峰,李全,殷勇.双小切口前路颈椎椎间盘切除融合术治疗连续4节段脊髓型颈椎病[J].脊柱外科杂志,2020,18(1):19-23,57. |
双小切口前路颈椎椎间盘切除融合术治疗连续4节段脊髓型颈椎病  点此下载全文 (Fulltext) |
| 沈宝良1 沈洪兴1 2* 陈智2 劳立峰2 李全2 殷勇1 |
1. 上海健康医学院附属嘉定区中心医院骨科, 上海 201800;
2. 上海交通大学附属仁济医院骨科, 上海 200001 |
| 基金项目： |
| DOI：10.3969/j.issn.1672-2957.2020.01.005 |
| 摘要点击次数: 411 |
| 全文下载次数: 261 |
| 摘要： |
| 目的 比较单/双小切口前路颈椎椎间盘切除融合术（ACDF）治疗连续4节段脊髓型颈椎病（CSM）的疗效及术后并发症发生情况。方法 回顾性分析2014年10月—2017年9月上海交通大学附属仁济医院骨科采用ACDF治疗的64例连续4节段CSM患者临床资料，根据手术切口分为单切口组（n=31，SI）和双小切口组（n=33，DI）。比较2组手术切口、颈肩疼痛视觉模拟量表（VAS）评分，日本骨科学会（JOA）评分和改善率；记录并比较术后并发症发生情况（切口感染、吞咽困难、声音嘶哑、C5神经根麻痹和脑脊液漏）。结果 所有手术均顺利完成。所有患者随访时间>12个月，最长2.5年。2组患者术后72 h切口疼痛均明显缓解，术后3个月切口疼痛基本消失。末次随访时，2组患者VAS评分和JOA评分均较术前显著改善，差异有统计学意义（P<0.05），组间比较差异无统计学意义（P>0.05）。SI组16例发生手术并发症，其中切口感染1例，吞咽困难11例，声音嘶哑2例，C5神经根麻痹1例，脑脊液漏1例；DI组5例发生手术并发症，吞咽困难3例，声音嘶哑1例，C5神经根麻痹1例。结论 对于以前方脊髓压迫为主的连续4节段CSM，采用单/双小切口ACDF治疗，均能有效改善患者的神经功能，缓解颈肩疼痛，但双小切口可有效降低术后吞咽困难发生率。 |
| 关键词：颈椎 颈椎病 椎间盘切除术 脊柱融合术 减压术，外科 |
| Anterior cervical discectomy and fusion with double mini-ncisions for 4-segment cervical spondylotic myelopathy Fulltext |
| SHEN Bao-liang1 SHEN Hong-xing1 2* CHEN Zhi2 LAO Li-feng2 LI Quan2 YIN Yong1 |
1. Department of Orthopaedics, Central Hospital of Jiading District, Shanghai University of Medicine and Health Sciences, Shanghai 201800, China;
2. Department of Orthopaedics, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200001, China |
| Fund Project: |
| Abstract: |
| Objective To compare the efficacy and complications of anterior cervical discectomy and fusion (ACDF) with single/double mini-incisions in the treatment of 4-segment cervical spondylotic myelopathy(CSM). Methods The clinical data of 64 patients with 4-segment CSM treated with ACDF in Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from October 2014 to September 2017 were analyzed retrospectively. They were divided into single incision group (n=31, SI) and double mini-incision group (n=33, DI) according to the surgical incision. The surgical incision, neck and shoulder pain visual analogue scale (VAS) scores, Japanese Orthopaedic Association (JOA) score and improvement rate were compared between the 2 groups. Postoperative complications (incision infection, dysphagia, hoarseness, C5 nerve root paralysis and cerebrospinal fluid leakage) in the 2 groups were recorded and compared. Results All the operations were successfully completed. All the patients were followed up >12 months, with a maximum period of 2.5 years. The incision pain was relieved in both groups at postoperative 72 h, and almost disappeared at postoperative 3 months. At the final follow-up, the VAS and JOA scores of the 2 groups were significantly improved compared with those of the pre-operation, with statistical significances (P<0.05), and there was no significant difference between the 2 groups(P>0.05). In SI group, 16 patients sufferred surgical complications, including incision infection in 1, dysphagia in 11, hoarseness in 2, C5 nerve root paralysis in 1 and cerebrospinal fluid leakage in 1. In DI group, 5 patients sufferred surgical complications, including dysphagia in 3, hoarseness in 1 and C5 nerve root paralysis in 1. Conclusion For 4-segment CSM with anterior spinal cord compression, ACDF with single/double mini-incision can effectively improve neurological function and relieve neck and shoulder pain, but double mini-incision can effectively reduce the incidence of dysphagia. |
| Keywords:Cervical vertebrae Cervical spondylosis Diskectomy Spinal fusion Decompression, surgical |
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