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陈竞轩,张志超,石维,唐一钒,周盛源,贾连顺,陈雄生*.改良颈椎前路单椎体次全切除融合术并单节段颈椎前路椎间盘切除融合术治疗多节段脊髓型颈椎病[J].脊柱外科杂志,2021,19(2):94-99.
改良颈椎前路单椎体次全切除融合术并单节段颈椎前路椎间盘切除融合术治疗多节段脊髓型颈椎病     点此下载全文 (Fulltext)
陈竞轩  张志超  石维  唐一钒  周盛源  贾连顺  陈雄生*
海军军医大学长征医院骨科, 上海 200003
基金项目:
DOI:10.3969/j.issn.1672-2957.2021.02.005
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全文下载次数: 23
摘要:
      目的 探讨改良颈椎前路单椎体次全切除融合术(ACCF)并单节段颈椎前路椎间盘切除融合术(ACDF)治疗连续3节段椎间盘突出并椎管狭窄的脊髓型颈椎病(CSM)的可行性、安全性和有效性。方法 2010—2018年本院收治3节段椎间盘突出并椎管狭窄的CSM患者379例,其中133例采用传统单节段ACCF并ACDF治疗,并以长钛板固定ACCF和ACDF节段(传统组);246例采用改良单节段ACCF并ACDF治疗,以短钛板固定ACCF手术节段,采用单纯椎间融合器重建ACDF节段(改良组)。统计并比较2组患者手术时间、住院时间、术中出血量、术中输血情况、手术前后日本骨科学会(JOA)评分和疼痛视觉模拟量表(VAS)评分、融合器与钛网相对位置、术后并发症、颈椎活动度(ROM)、ACDF节段椎间隙高度及术后症状复发情况。结果 所有手术顺利完成。所有患者随访超过1年。2组术后JOA评分及VAS评分均较术前显著改善,差异有统计学意义(P<0.05)。改良组术中出血量及术后吞咽困难发生率低于传统组,差异有统计学意义(P<0.05)。改良组术前VAS评分≥2分者术后1年JOA评分改善率高于术前VAS评分< 2分者,差异有统计学意义(P<0.05)。结论 改良单节段ACCF并ACDF治疗连续3节段椎间盘突出并椎管狭窄的CSM安全有效,且术中出血量更少,术后吞咽困难发生率更低。
关键词:颈椎  颈椎病  椎间盘切除术  脊柱融合术  减压术,外科
Treatment of multilevel cervical spondylotic myelopathy with modified single-segment anterior cervical corpectomy and fusion and anterior cervical discectomy and fusion    Fulltext
Chen Jingxuan  Zhang Zhichao  Shi Wei  Tang Yifan  Zhou Shengyuan  Jia Lianshun  Chen Xiongsheng*
Department of Orthopaedics, Changzheng Hospital, Navy Medical University, Shanghai 200003, China
Fund Project:
Abstract:
      Objective To investigate the feasibility,safety and effectiveness of modified single-segment anterior cervical corpectomy and fusion(ACCF) combined with single-segment anterior cervical discectomy and fusion(ACDF) in the treatment of cervical spondylotic myelopathy(CSM) with three consecutive levels of disc herniation and spinal stenosis. Methods From 2010 to 2018,379 CSM patients with three-level disc herniation and spinal stenosis admitted were treated in our hospital. Among them,133 cases were treated with traditional single-segment ACCF and ACDF,and long titanium plate was used to fix ACCF and ACDF segments(tradition group);246 cases were treated with modified single-segment ACCF and ACDF,short titanium plate was used to fix ACCF segment,and simple interbody fusion cage was used to reconstruct ACDF segment(modified group). The operation time,hospital stay,intraoperative blood loss,intraoperative blood transfusion,Japanese Orthopaedic Association(JOA) score and visual analogue scale(VAS) score before and after operation,relative position of fusion cage and titanium mesh,postoperative complications,cervical range of motion(ROM),height of ACDF intervertebral space and recurrence of symptoms were compared between the 2 groups. Results All the operations were completed successfully. All the patients were followed up for more than 1 year. The JOA score and VAS score of the 2 groups were significantly improved at post-operation compared with those at pre-operation,all with a statistical significance(P<0.05). The intraoperative blood loss and the incidence of postoperative dysphagia in modified group were lower than those in the tradition group,all with a statistical significance(P<0.05). In the modified group,the improvement rate of JOA score at postoperative 1 year in patients with preoperative VAS score ≥ 2 was higher than that in patients with preoperative VAS score < 2,and the difference was statistically significant(P<0.05). Conclusion Modified single-segment ACCF combined with ACDF is safe and effective in the treatment of CSM with three consecutive segments of disc herniation and spinal stenosis,with less intraoperative blood loss and lower incidence of postoperative dysphagia.
Keywords:Cervical vertebrae  Cervical spondylosis  Diskectomy  Spinal fusion  Decompression,surgical
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