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袁一,李翔宇,刘承鑫,史彬,王东凡,王宇,孔超,鲁世保.不同术式对多节段脊髓型颈椎病患者颈椎矢状位形态的矫形效果[J].脊柱外科杂志,2022,20(5):302-306,312.
不同术式对多节段脊髓型颈椎病患者颈椎矢状位形态的矫形效果     点此下载全文 (Fulltext)
袁一1  李翔宇2  刘承鑫2  史彬2  王东凡2  王宇2  孔超2  鲁世保2*
1. 北京市第六医院骨科, 北京 100007;
2. 首都医科大学宣武医院骨科, 北京 100053
基金项目:
DOI:10.3969/j.issn.1672-2957.2022.05.003
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摘要:
      目的 通过对比颈椎前路椎间盘切除融合术(ACDF)、椎板切除融合术(LCF)和椎板成形术(LP)后颈椎矢状位形态改变情况,比较三者对多节段脊髓型颈椎病(MCSM)患者颈椎矢状位的矫形效果及对矫形效果的维持能力。方法 2016年1月—2019年12月,首都医科大学宣武医院收治MCSM患者188例,其中47例采用ACDF治疗(ACDF组)、72例采用LCF治疗(LCF组),69例采用LP治疗(LP组)。根据术前颈椎前凸角(CL,C2-7 Cobb角)将患者分为后凸型(CL < 0°)、平直型(0°≤CL < 10°)、前凸型(10°≤CL < 20°)和过度前凸型(CL≥20°)。根据术前和术后CL计算不同术式的前凸改变量(末次随访CL-术前CL)、前凸矫正量(术后1周CL-术前CL)和前凸丢失量(术后1周CL-末次随访CL)。采用日本骨科学会(JOA)评分和颈椎功能障碍指数(NDI)评估临床疗效。结果 3组临床疗效差异无统计学意义。ACDF组前凸改变量、前凸矫正量大于LCF组和LP组,差异均有统计学意义(P < 0.05)。ACDF可增加后凸型、平直型和前凸型患者的CL,随访中虽有部分丢失,但至末次随访时矫形效果维持良好;过度前凸型患者术后CL轻微增加,但随访时逐渐减小,过度前凸缓解。LCF可增加后凸型、平直型患者的CL,随访中前凸丢失量少于ACDF,但末次随访时矫形效果仍不如ACDF。LP术后各型患者CL均降低,但随访过程中前凸丢失量小于ACDF和LCF。结论 ACDF矫形能力较强,可用于治疗各种颈椎曲度类型MCSM患者,LCF适用于后凸型、平直型MCSM患者,LP可用于治疗CL > 10°的MCSM患者。MCSM手术方式的选择除常规考虑脊髓压迫位置、手术节段等,还应考虑患者颈椎矢状位形态特点。
关键词:颈椎  颈椎病  椎间盘切除术  椎板切除术  脊柱融合术  椎板成形术
Orthopedic effect of different surgical methods for sagittal morphology of cervical spine in patients with multilevel cervical spondylotic myelopathy    Fulltext
Yuan Yi1  Li Xiangyu2  Liu Chengxin2  Shi Bin2  Wang Dongfan2  Wang Yu2  Kong Chao2  Lu Shibao2*
1. Department of Orthopaedics, Beijing No. 6 Hospital, Beijing 100007, China;
2. Department of Orthopaedics, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
Fund Project:
Abstract:
      Objective To compare the changes of cervical sagittal morphology after anterior cervical discectomy and fusion(ACDF),laminectomy and fusion(LCF) and laminoplasty(LP),and to compare the orthopedic effect and its maintenance ability of the 3 methods on the sagittal morphology of multilevel cervical spondylotic myelopathy(MCSM) patients.Methods From January 2016 to December 2019,188 patients with MCSM were treated in Xuanwu Hospital of Capital Medical University,of which 47 were treated with ACDF(ACDF group),72 with LCF(LCF group) and 69 with LP(LP group).According to the preoperative cervical lordosis(CL,C2-7 Cobb angle),the patients were divided into kyphosis type(CL < 0°),straight type(0° ≤ CL < 10°),lordosis type(10° ≤ CL < 20°) and excessive lordosis type(CL ≥ 20°).According to the preoperative and postoperative CL,the lordosis change(CL at final follow-up-preoperative CL),the lordosis correction(CL at postoperative 1 week-preoperative CL) and the lordosis loss(CL at postoperative 1 week-CL at final follow-up) were calculated.The clinical efficacy was evaluated by Japanese Orthopaedic Association(JOA) score and neck disability index(NDI).Results There was no significant difference in the clinical efficacy between the 3 groups.The amount of lordosis correction in ACDF group was greater than that in LCF group and LP group,and the differences were statistically significant(P < 0.05).ACDF increased CL in kyphosis,straight and lordosis type patients,although CL was partially lost during follow-up,the orthopedic effect remained good until the final follow-up.In excessive lordosis type patients,the CL increased slightly after ACDF,but gradually decreased during follow-up,and the excessive lordosis was relieved.LCF increased CL in kyphosis and straight type patients.The amount of lordosis loss was less than that of ACDF during follow-up,but the orthopedic effect was still not as good as that of ACDF at the final follow-up.CL in all the types of patients after LP decreased,but the amount of lordosis loss was less than that of ACDF and LCF during follow-up.Conclusions ACDF has strong orthopedic ability and can be used to treat MCSM patients with various cervical curvature types.LCF is suitable for MCSM patients in kyphosis or straight type.LP can be used to treat MCSM patients with CL > 10°.The selection of operation method for MCSM should not only consider the position of spinal cord compression and surgical segments,but also consider the cervical sagittal morphological characteristics.
Keywords:Cervical vertebrae  Cervical spondylosis  Diskectomy  Laminectomy  Spinal fusion  Laminoplasty
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