ACDF与ACCF手术对多节段颈椎病患者颈椎活动度及并发症的影响

doi:10.3969/j.issn.1007-3205.2021.08.007

摘要/Abstract

摘要： 目的分析颈前路椎间盘切除植骨融合术（anterior cervical discectomy and fusion,ACDF）与颈前路椎体次全切除植骨融合术（anterior cervical corpectomy and fusion,ACCF）治疗多节段颈椎病患者的效果及对颈椎活动度与术后并发症的影响。
方法对实施手术治疗的多节段颈椎病患者60例临床资料进行回顾性分析，根据手术方式分为ACDF组28例、ACCF组32例，观察两组患者的手术时间、术中出血量、住院时间及术后并发症发生情况，并采用视觉模拟（visual analogue scale，VAS）评分、日本矫形外科学会（Japan Orthopaedic Assoctiation，JOA）评分对两组患者的疼痛程度及神经功能进行评价，并对术前术后两组患者的颈椎曲度、颈椎活动度等指标进行观察记录。
结果 ACCF组术中出血量显著高于ACDF组，差异有统计学意义（P＜0.05）；ACDF组手术时间显著低于ACCF组，差异有统计学意义（P＜0.05）。患者术前、术后3个月时ACDF、ACCF组JOA评分比较，差异无统计学意义（P＞0.05）；两组术后3个月时JOA评分明显高于术前，差异有统计学意义（P＜0.05）。术前、术后3个月ACDF、ACCF组患者颈椎曲度、颈椎活动度比较，差异有统计学意义（P＜0.05）；术前、术后3个月时颈椎曲度、颈椎活动度组间比较差异有统计学意义（P＜0.05）。ACDF组患者未发生并发症，ACCF组发生声音嘶哑3例、切口感染2例、植骨未融合1例；总发生率比较，差异有统计学意义（P＜0.05）。
结论 ACDF与ACCF可显著改善患者颈椎活动度，两者效果相当，但ACDF患者术中出血量更少、手术时间更短，并发症更少。

关键词: 椎间盘切除术, 颈椎病, 手术后并发症

Abstract: Objective To analyze the effect of anterior cervical discectomy and fusion(ACDF) and anterior cervical corpectomy and fusion(ACCF) in the treatment of patients with multilevel cervical spondylopathy and the influence on cervical spine range of motion(ROM) and postoperative complications.
Methods The clinical data of 60 patients with multilevel cervical spondylopathy who received surgery in our hospital were retrospectively analyzed. According to different operation methods, they were divided into ACDF group(n=28) and ACCF group(n=32). The duration of operation, intraoperative blood loss, duration of hospital stay and postoperative complications of patients in two groups were observed. The visual analogue(VAS) score and the Japan Orthopaedic Association(JOA) score were used to evaluate the pain degree and neurological function of patients in two groups, and the cervical spine curvature and cervical spine ROM of patients in two groups before and after operation were observed and recorded.
Results The intraoperative blood loss in ACCF group was significantly higher than that in ACDF group, and the difference was statistically significant(P＜0.05). The duration of operation in ACDF group was significantly lower than that of ACCF group, and the difference was statistically significant(P＜0.05). There was no significant difference in JOA scores between ACDF and ACCF groups before and at 3 months after operation(P＞0.05), and JOA score of the two groups at 3 months after operation was significantly higher than that before operation, suggesting significant difference(P＜0.05). There were significant differences in cervical spine curvature and ROM between ACDF and ACCF groups before and at 3 months after operation(P＜0.05). Significant difference was found in the cervical spine curvature and ROM before and at 3 months after operation(P＜0.05). No complication occurred in ACDF group, and complication was observed in 6 cases in ACCF group, including 3 cases of hoarseness, 2 cases of incision infection and 1 case of non-fusion; the total incidence was statistically significant(P＜0.05).
Conclusion ACDF and ACCF can significantly improve the ROM of the cervical spine, and both have good effects. However, patients undergoing ACDF have less intraoperative blood loss, shorter duration of operation, and fewer complications.

Key words: diskectomy, , cervical spondylosis, , postoperative complications

杨赛, 巩陈, 周盛源. ACDF与ACCF手术对多节段颈椎病患者颈椎活动度及并发症的影响[J]. 河北医科大学学报, 2021, 42(8): 896-899.

YANG Sai, GONG Chen, ZHOU Sheng-yuan. Effect of ACDF and ACCF on cervical spine range of motion and complications in patients with multilevel cervical spondylosis[J]. Journal of Hebei Medical University, 2021, 42(8): 896-899.

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ACDF与ACCF手术对多节段颈椎病患者颈椎活动度及并发症的影响

Effect of ACDF and ACCF on cervical spine range of motion and complications in patients with multilevel cervical spondylosis

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