颈椎间盘置换及前路椎间融合治疗单节段颈椎间盘突出症：谁更多影响邻近节段发生退变？

摘要

背景：有研究表明，颈椎间盘置换及前路固定融合治疗颈椎病可以取得较好的临床效果，但是哪种术式在避免邻近节段退变方面更具优势尚无定论。目的：比较颈椎间盘置换与前路固定融合治疗单节段颈椎间盘突出症对邻近节段的近期影响。方法：收集2009年1月至2012年12月以“颈椎间盘突出症”为诊断收入院并行单节段颈椎间盘置换或颈前路椎间盘切除融合患者178例的临床资料，进行回顾性分析，其中前路固定融合组116例，颈椎间盘置换组62例。结果与结论：①评价：两组患者末次随访时目测类比评分、日本骨科协会评估治疗评分、颈椎功能障碍指数均较治疗前明显改善(P <0.05)。②末次随访时手术节段、邻近上位节段及邻近下位节段活动度与术前相比，颈椎间盘置换组差异均无显著性意义(P >0.05)。前路固定融合组术后3个月时手术节段基本融合，活动度丧失，末次随访时邻近上位节段活动度与邻近下位节段活动度明显增加，且上位节段活动度增加的度数较下位节段大(P <0.05)。③末次随访时 X 射线图像及 MRI 图像显示：前路固定融合组发生邻近节段退变的数量均多于颈椎间盘置换组(P <0.05)，两组中上位节段退变的数量均多于下位节段(P <0.05)。④结果证实，颈椎间盘置换或前路固定融合治疗颈椎间盘突出症，均能够有效地解除患者的神经症状，但与颈椎间盘置换相比，前路固定融合后邻近节段退变的发生更常见。%BACKGROUND: Studies showed that both anterior cervical disc replacement and anterior cervical decompression and fusion can achieve good clinical result in cervical spondylosis. However, it is not conclusive about which kind of surgical method has an advantage in avoiding the adjacent segment degeneration. OBJECTIVE: To compare the effect on adjacent segment degeneration of single segment cervical disc herniation treated with anterior cervical decompression and fusion and anterior cervical disc replacement. METHODS: We col ected clinical data of 178 patients with cervical disc herniation and receiving anterior cervical disc replacement or anterior cervical decompression and fusion from January 2009 to December 2012. A retrospective analysis was performed. There were 116 cases in the anterior cervical decompression and fusion group and 62 cases in the anterior cervical disc replacement group. RESULTS AND CONCLUSION: (1) Evaluation: visual analogue scale score, Japanese Orthopaedic Association Scores and neck disability index were improved significantly in both groups during final fol ow-up compared with that pre-treatment (P < 0.05). (2) No significant difference in range of motion of operation segment, adjacent upper segment and adjacent lower segment was detected between final fol ow-up and pre-operation in the anterior cervical disc replacement group (P > 0.05). At 3 months after surgery, in the anterior cervical decompression and fusion group, surgical segment was confluent, and range of motion lost. During final fol ow-up, range of motion of adjacent upper segment and adjacent lower segment was significantly increased, and the increased range of motion in the upper segment was bigger than that of the lower segment (P < 0.05). (3) During final fol ow-up, X-ray films and MRI images revealed the number of degenerated adjacent segment was more in the anterior cervical decompression and fusion group than in the anterior cervical disc replacement group (P <0.05). The number of degenerated middle and upper segments was more than that of the lower segment in both groups (P < 0.05). (4) The findings confirmed that anterior cervical disc replacement or anterior cervical decompression and fusion for treating cervical disc herniation could effectively relieve nerve symptoms of patients. However, compared with the anterior cervical disc replacement, adjacent segment degeneration occurs more commonly after anterior cervical decompression and fusion.