ACCF和双节段ACDF治疗连续双间隙颈椎间盘突出脊髓型颈椎病的影像学疗效
Clinical effects of ACCF and double-segment ACDF in treating continuous double-gap cervical spondylotic myelopathy

摘要：目的 对颈前路椎体次全切除融合术(ACCF)与连续双节段双间隙颈前路椎间盘切除融合术(ACDF)术后患者影像学解剖参数、相关围手术期参数进行比较，了解两种术式术后患者颈椎影像学的变化及临床疗效的差异性。方法 回顾性纳入西安交通大学第二附属医院骨科241例连续双间隙颈椎间盘突出脊髓型颈椎病患者，ACDF组51例[男∶女=32∶19，平均年龄(56.3±29.4)岁]；ACCF组47例[男∶女=35∶12，平均年龄(49.1±22.8)岁]。观察指标：性别比例、平均年龄、平均住院时间、平均手术时间、平均术中出血量；术前、术后1d、术后6个月、术后1年、术后2年的JOA评分和影像学观察指标。采用SPSS 19.0软件对上述指标进行统计学分析。结果 ACDF组患者较ACCF组有较短的手术时间、手术出血量和较短的住院时间；ACDF组患者较ACCF组患者的术后JOA评分无显著性差异；ACDF组患者较ACCF组患者有着较佳的影像学指标。结论 在治疗连续双间隙颈椎间盘突出脊髓型颈椎病方面，ACDF较ACCF的影像学观察所见疗效更佳。
ABSTRACT: Objective To compare the postoperative imaging anatomical parameters and the related perioperative parameters of continuous double-gap cervical spondylotic myelopathy patients who underwent anterior cervical disectomy and fusion (ACDF) or anterior cervical corpectomy and fusion (ACCF) and ACDF so as to learn about the clinical effects of the two methods. Methods We included 51 patients in ACDF group (male∶female ratio=32∶19; mean age 56.3±29.4 years), and 47 patients (male∶female ratio=35∶12; mean age 49.1±22.8 years) in ACCF group. We measured the sex ratio, mean age, average length of hospital stay, mean operative time, and average intraoperative blood loss in ACDF group and ACCF group. The patients were followed up at six months, 1 year, and 2 years after operation. The JOA score and imaging parameters were recorded for statistical analysis by SPSS 19.0. Results Patients in ACDF group had shorter operative time, less operative bleeding and shorter hospitalization duration than those in ACCF group. There was no significant difference in postoperative JOA score between ACDF and ACCF group. Patients in ACDF group had better imaging indexes than those in ACCF group. Conclusion ACDF has better screening efficacy than ACCF in treatment of continuous double-gap cervical disc herniation of cervical spondylotic myelopathy