| BackgroundCervical spondylotic myelopathy has a high disability rate and needs surgical treatment as soon as possible.However,at present,there is no consensus on the choice of surgical methods for multi-segment cervical spondylotic myelopathy.The anterior cervical hybrid surgery is a combination of anterior cervical fusion surgery and replacement surgery,which has a definite therapeutic effect on degenerative cervical spondylosis.However,there are few reports on the treatment of multi-segment cervical spondylotic myelopathy.ObjectiveTo summarize the surgical effect of Hybrid surgery in the treatment of multi-segment cervical spondylotic myelopathy,and to provide reference for the selection of surgical options for multi-segment cervical spondylotic myelopathy.At the same time,to evaluate the heterotopic ossification after Hybrid surgery and its high risk factors.MethodFifty patients with multi-segment cervical spondylotic myelopathy who received Hybrid surgery in the Department of Orthopaedics,Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University from July 2017 to March 2020 were included in the study,all of which were two-level or three-level.Complete clinical data were obtained and 50 patients were followed up,including 23 males and 27 females.The average age was(58.48±11.96)years,the intraoperative blood loss was 3-300ml,the average was(61.3 6±53.09)ml,the operative time was 90-335 minutes,the average was(191.66±54.42)minutes,the hospital stay was 4-28 days,the average was(10.16±4.30)days.The follow-up time was 36-67 months,with an average of(49.4±9.92)months.In 31 cases,C5/6 replacement+C6/7 fusion in 16 cases,C4/5 replacement+C5/6 fusion in 7 cases,C4/5 fusion+C5/6 replacement in 6 cases,C3/4 replacement+C4/5 fusion in 1 case,C5/6 fusion+C6/7 replacement in 1 case.19 cases of three-level surgery,7 cases of C4/5 replacement+C5/6,C6/7 fusion,3 cases of C3/4,C4/5 fusion+C5/6 replacement,3 cases of C4/5,C6/7 fusion+C5/6 replacement,2 cases of C3/4,C6/7 fusion+C4/5 replacement,1 case of C3/4,C5/6 fusion+C4/5 replacement.There was 1 case of C3/4 and C6/7 fusion+C5/6 replacement,1 case of C5/6 fusion+C3/4 and C6/7 replacement,and 1 case of C3/4 replacement+C5/6 and C6/7 fusion.A total of 51 artificial cervical discs and 63 fusion devices were implanted in 50 patients.All included patients received ROI-C fusion(LDR Medical,France)and Mobi-C cervical artificial discs(LDR Medical,France).Clinical efficacy evaluation indexes and imaging indexes of patients at three time points before surgery,3 days after surgery and the last follow-up were collected.JOA score,YT20 score and Odom’s score were used to evaluate the clinical efficacy of the patients,and McAfee grading standard was used to evaluate HO after cervical disc implantation.Ho was divided into ectopic ossification group and non-ectopic ossification group according to HO,and the differences between the two groups were compared and analyzed to analyze the risk factors of ectopic ossification.Results1 Clinical efficacy resultsAt the last follow-up,the clinical symptoms of 50 patients were significantly relieved compared with before,and the curative effect was satisfactory.The YT20 score of the patients increased gradually from preoperative to the last follow-up.The YT20 score of the patients after operation(19.04±1.55)was significantly higher than that before operation(10.96±3.87)(P<0.01),and the total JOA score(16.54±0.71)was significantly higher than that before operation(12.92±2.52)(P<0.01).The average JOA improvement rate was 81.53%,and 100%(50/50)of them were excellent or good at the last follow-up.2 Imaging results2.1 Status of heterotopic ossificationHeterotopic ossification was found in 24 patients(48%)at the last follow-up.According to McAfee classification,there were 7 cases of grade Ⅰ(29.17%),8 cases of grade Ⅱ(33.33%),7 cases of grade Ⅲ(29.17%),and 2 cases of grade Ⅳ(8.33%).2.2 Comparison between heterotopic ossification group and non-heterotopic ossification groupAccording to the presence or absence of heterotopic ossification,50 patients were divided into heterotopic ossification group and non-heterotopic ossification group.There was no significant difference in gender,age,segment,blood loss,operation time,hospitalization time,preoperative YT20 score,and preoperative JOA score between the two groups(P>0.05).At the last follow-up,the YT20 score and JOA score of the two groups were significantly higher than those before operation,and the differences were statistically significant(P<0.001).The YT20 score of heterotopic ossification group(18.75±1.62)was lower than that of nonheterotopic ossification group(19.30±1.46)at the last follow-up(P<0.05).The average JOA improvement rate was 86.49%in the non-heterotopic ossification group and 77.43%in the heterotopic ossification group,with no significant difference(P>0.05).3.High risk factors of heterotopic ossificationSmoking history,age,gender,operation time,blood loss,length of hospital stay,segment and body mass index were included to construct a multivariate Logistic regression equation.The results showed that smoking history increased the risk of heterotopic ossification(OR=8.538,95%CI 1.407-51.796,P<0.05).Conclusion:Hybrid surgery for multi-segment cervical spondylotic myelopathy has a good clinical effect.Smoking history is a risk factor for HO. |
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