人工椎间盘置换术联合颈椎前路融合术治疗脊髓型颈椎病的治疗效果及安全性

寇宏斌，孙侃良，何思远，赵毅，李俊

（陕西省商洛市商州区人民医院，陕西 商洛，726000）

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摘要：

目的 分析应用人工椎间盘置换术联合颈椎前路融合术治疗脊髓型颈椎病的治疗效果及安全性。方法 选取医院接受 治疗的76 例脊髓型颈椎病患者，随机分为对照组与联合组，每组38 例。对照组患者应用椎间盘切除植骨内固定术治疗，联 合组患者应用人工椎间盘置换术联合颈椎前路融合术治疗。比较两组患者手术结束后1 年的颈椎整体活动度、神经功能和 手术状况。结果 两组患者术前的JOA 评分和颈椎整体活动度比较，差异不具有统计学意义（P>0.05），两组患者术后1 年的 JOA 评分均显著高于术前（P<0.05）。术后1 年，两组患者的颈椎整体活动度均明显改善，且联合组明显优于对照组（P<0.05）。联合组患者的手术时间与出血量均明显优于对照组（P<0.05）。结论 应用人工椎间盘置换术联合颈椎前路融合术治疗脊髓 型颈椎病能够有效地提患者的颈椎整体活动度，降低患者术中的出血量与手术时间，具有较高的安全性，值得临床推广。

关键词：脊髓型颈椎病；人工椎间盘置换术；颈椎前路融合术

中图分类号：R687.3文献标志码：A文章编号：2096-1413(2018)01-0053-02

Clinical effect and safety of artificial disc replacement surgery combined with anterior cervical fusion surgery in the treatment of cervical spondylotic myelopathy
KOU Hong-bin, SUN Kan-liang, HE Si-yuan, ZHAO Yi, LI Jun
(People``s Hospital of Shangzhou District in Shangluo, Shangluo 726000, China)

ABSTRACT: Objective To analyze the clinical effect and safety of artificial disc replacement surgery combined with anterior cervical fusion surgery in the treatment of cervical spondylotic myelopathy. Methods A total of 76 patients with cervical spondylotic myelopathy treated in the hospital were selected and randomly divided into control group and combined group, with 38 cases in each group. The control group was treated with discectomy and bone grafting surgery, and the combined group performed artificial disc replacement surgery combined with anterior cervical fusion surgery. The overall activity, neurological function at 1 year after operation and operation conditions were compared between the two groups. Results There were no significant differences in the JOA scores and overall activity of the cervical spine between the two groups before and at 1 year after operation (P>0.05), but at 1 year after operation, the JOA scores in the two groups were higher than those before operation (P<0.05). At 1 year after operation, the overall activity of the cervical spine in the two groups improved obviously, and that in the combined group were significantly better than that in the control group (P<0.05). The operation time and the amount of bleeding in the combined group were significantly better than those in the control group (P<0.05). Conclusion Artificial disc replacement surgery combined with anterior cervical fusion surgery can effectively improve the overall activity of cervical spine in patients with cervical spondylotic myelopathy, reduce the amount of bleeding and operation time, which has high security and is worthy of promotion in clinic.
KEYWORDS: cervical spondylotic myelopathy; artificial disc replacement surgery; anterior cervical fusion surgery

参考文献：
[1] 张一龙,陈仲强,孙宇,等.脊髓型颈椎病患者术后神经功能与生活质量的变化及其之间的相关性分析[J].中国脊柱脊髓杂志,2016,26(9):782-790.
[2] 孙天威,张杭,卢守亮,等.颈椎单开门椎管扩大成形术椎板开门角度对脊髓型颈椎病疗效的影响[J].中国脊柱脊髓杂志,2012,22(1):8-13.
[3] MIYAMOTO H,MAENO K,UNO K,et al.Outcomes of surgical intervention for cervical spondylotic myelopathy accompanying local kyphosis (comparison between laminoplasty alone and posterior reconstruction surgery using the screw -rod system) [J].Eur Spine J, 2014,23(2):341-346.
[4] 张一龙,周非非,孙宇,等.脊髓型颈椎病手术治疗后的近中期JOA 评分变化规律[J].中国脊柱脊髓杂志,2015,25(1):13-17.
[5] YOSHIDA G,KANEMURA T,ISHIKAWA Y,et al.The effects of surgery on locomotion in elderly patients with cervical spondylotic myelopathy[J].Eur Spine J,2013,22(11):2545-2551.
[6] 王华仁,陈少文,杨焱鑫,等.两种颈前路术式治疗老年患者双节段 脊髓型颈椎病的疗效比较[J].中国老年学,2016,36(22):5668-5670.