| Anterior cervical discectomy and fus ion (ACDF), the treatment of cervical spondylosis ACDF is la classic and effective operation method, but the larger adjacent segmental mobiity, degeneration speed, reduce the complications such as cervical overall mobility has aroused much attention. Between artificial cervical disc replacement (ACDR) can reduce the complications, when patients with a smaller segmental mobility, narrow gap, while another section still has a certain activity, can be combined with ACDF ACDR Hybrid surgery, part of the section to maintain the operation activity, and thus reduce some complications.Objective:Screening of Beijing university of Chinese medicine dongzhimen hospital orthopaedic centre since June2013-02,2012through double segmental Hybrid, a total of17patients with surgical treatment of cervical spondylosis, through to the before and after surgery in the patients with symptoms and imaging data were analyzed, and further is double segmental Hybrid combination (Cage ACDR) with double segmental ACDF surgery, for cervical spondylosis postoperative clinical curative effect and its influence on the near future, adjacent cervical segments were studied.methods:Hybrid surgery patients a total of17cases,12cases of men, women in5cases;3266years old, average53.7years; Preoperative duration (time from onset to surgery)0.5-61months, an average of26.4months. Are clear in patients with preoperative cervical spondylosis related clinical symptoms, which is characterized by simple nerve root signs are6cases, simple in6cases, spinal cord compression symptoms and symptoms associated with nerve roots and spinal cord compression symptoms in5cases. Shown in all patients with preoperative imaging examination in place with consistent, C4/5,11patients wi th C5/6lesions, C5/6,6patients wi th C6/7les ions. Pat ients were t reated wi th different types of conservative treatment (including rest, physical therapy, massage, traction, acupuncture and moxibustion, etc.), each containing two groups of patients with symptoms worsen in conservative accepted surgical treatment after half month, the rest of the patients for3months or more conservative, preoperative conservative treatment has been unable to relieve symptoms. Contrast group (ACDF)(data) courts recently selected17double segmental ACDF patients, routine into a set of standards:(1) patients with diagnosis of cervical spondylosis clinical signs and symptoms and the corresponding imaging evidence as evidence;(2) the preoperative have received conservative treatment, and conservative treatment has failed to relieve symptoms;(3) in the surgery of two segments, a preoperative cervical segments has kept>3°cervical activity as a whole. ACDF group of14cases of the men and women (3cases);43-68years old, average56.4years old;Preoperative duration of0.5-120months, an average of28.9months.Two groups of patients’ age, gender, duration matching, operation segment is the same as the Hybrid either surgery patients.Research results:1,3,6months after Hybrid JOA, NDI score group, the ACDF group were obviously improved than before, but have significant statistical significance (P<0.05); At the time of1,3months fol low-up JOA score is simi lar between the two groups was statistically significant (P<0.05, table2),6months postoperative JOA score compared two groups, the difference was not statistically significant. Odom Hybrid group evaluation results:optimal,9cases;Good,7cases; Generally,2cases, is16/17. Odom ACDF group evaluation results:optimal,8cases;Good,8cases;Generally,1case, fine rate is16/17. Hybrid group of1,3,6months after the C2/7, preoperative activity overall difference has statistical significance (P<0.05); ACDF group of1,3,6months after the C2/7, preoperative activity overall difference has statistical significance (P>0.05); Comparison between the two groups was statistically difference. Hybrid group1and3months after the upper and lower adjacent to the activity of the cervical intervertebral disc in the preoperative reduced, the difference was statistically significant (P<0.05); After6months of activity there was no statistically significant difference compared with the preoperative (P>0.05).1and3months after ACDF group compared with preoperative upper cervical intervertebral disc mobility decreased, when the difference was statistically significant (P<0.05); After6months when compared with preoperative rise., was statistically significant difference (P<0.05). ACDF group after1month now reduce the preoperative asked adjacent cervical disc mobility, the difference was statistical ly significant (P<0.05),3and6months after surgery the difference had statistical significance (P<0.05), lower adjacent up from preoperative cervical intervertebral disc mobility; Comparison between the two groups, the preoperative and postoperative1month when adjacent segmental motion differences between the two groups has no statistical significance (P>0.05),3and6months after surgery, the adjacent segmental motion differences between the two groups was statistically significant (P<0.05).Conclusion:Double segmental Hybrid with ACDF surgery treatment of cervical spondylosis recent effect has no obvious difference, all can obtain satisfactory clinical effect. Two groups of postoperative cervical vertebra in the short term to reduce the overall activity, and Hybrid treatment of postoperative cervical overall recovery faster, six months after the review of activity of cervical vertebra, recovered to preoperative levels for most of the Hybrid surgery, and fusion surgery group differences exist between statistical significance. Hybrid and its adjacent vertebral group activity of6months after no obvious difference compared with the preoperative, and ACDF group on6months after operation, lower the activity of the adjacent vertebral are also preoperative. For follow-up time is short, this study two groups of patients were not ASD, to evaluate the long-term efficacy of Hybrid operation can’t, Hybrid surgery whether to reduce the incidence of the ASD still needs further study, so for Hybrid operation still need further long-term follow-up studies. |
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