混合颈椎手术（单节段前路颈椎椎体次全切除融合术）与多节段前路颈椎间盘切除融合术术后再手术长期风险的比较：一项回顾性队列研究
Long-Term Risk of Reoperation after Hybrid Cervical Surgery with One-Level Anterior Cervical Corpectomy and Fusion versus Multilevel Anterior Cervical Discectomy and Fusion: A Retrospective Cohort Study.
文献信息
| PMID | 42893149 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Anthony N Baumann |
| 作者单位 | College of Medicine, Northeast Ohio Medical University, Rootstown, OH, USA. |
| 期刊 | Spine surgery and related research |
| SCI 分区 | Q3 |
| IF | 1.9 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 耳科 |
中文摘要
研究设计： 回顾性队列研究。
引言： 混合颈椎手术（HCS）包括单节段前路颈椎椎体次全切除融合术（1L-ACCF）联合前路颈椎间盘切除融合术（ACDF），是退变性颈椎脊髓病（DCM）标准多节段前路颈椎间盘切除融合术（mACDF）的替代技术，关于术后结局的证据有限。主要目的是比较混合颈椎手术（HCS）与多节段前路颈椎间盘切除融合术（mACDF）治疗退变性颈椎脊髓病（DCM）后4年再手术风险。其次，本研究评估手术技术与假关节形成、口服阿片类药物处方及术后吞咽困难的关联。
方法： 利用TriNetX数据库，我们识别了2004年至2020年间接受HCS联合1L-ACCF或≥4节段mACDF的成人（≥18岁）DCM患者。患者按手术类型分组，并使用再手术危险因素进行倾向性匹配。主要结局为再手术的风险比（[RR]，95%置信区间[CI]）；次要结局包括假关节形成、口服阿片类药物处方及术后吞咽困难的RR，以及口服阿片类药物处方的平均数量。
结果： 匹配后，每组有1,203例DCM患者（平均年龄=56岁）。在HCS联合1L-ACCF队列中，与mACDF队列相比，再手术风险显著更高（10.2% vs 7.6%；RR=1.34 [1.03-1.73]；p=0.0267），但假关节形成风险显著更低（22.6% vs 32.3%；RR=0.70 [0.61-0.80]；p<0.001），吞咽困难风险也显著更低（12.1% vs 18.8%；RR=0.65 [0.53-0.78]；p<0.001）。两组间口服阿片类药物处方的风险或平均数量无统计学显著差异（RR=0.96 [0.91-1.01]；8.4 vs 8.9；p=0.471）。
结论： 在成人DCM患者中，与mACDF相比，HCS联合1L-ACCF后再手术风险似乎更高。然而，与mACDF相比，HCS联合1L-ACCF与假关节形成和吞咽困难风险更低相关，口服阿片类药物处方无差异。在推荐DCM手术方式的复杂决策过程中，外科医生可以考虑这些权衡。
英文摘要
STUDY DESIGN: Retrospective cohort study.
INTRODUCTION: HCS involving one-level anterior cervical corpectomy and fusion (1L-ACCF) along with ACDF is an alternative technique to the standard of mACDF for DCM, with limited evidence available on postoperative outcomes. The primary objective is to compare 4-year reoperation risk after hybrid cervical surgery (HCS) versus multilevel anterior cervical discectomy and fusion (mACDF) in degenerative cervical myelopathy (DCM). Secondarily, the study evaluates the association of surgical technique with pseudoarthrosis, oral opioid prescriptions, and postoperative dysphagia.
METHODS: Using TriNetX, we identified adults (≥18 years) with DCM who underwent either HCS with 1L-ACCF or ≥4-level mACDF from 2004 to 2020. Patients were grouped by surgery type, and reoperation risk factors were used for propensity matching. The primary outcome was the risk ratio ([RR], 95% confidence interval [CI]) for reoperation; secondary outcomes included RRs for pseudoarthrosis, oral opioid prescriptions, and postoperative dysphagia, as well as the mean number of oral opioid prescriptions.
RESULTS: There were 1,203 patients with DCM per cohort (mean age=56 years) after matching. Within the HCS with 1L-ACCF cohort, compared to the mACDF cohort, there was a statistically significant greater risk of reoperation (10.2% vs 7.6%; RR=1.34 [1.03-1.73]; p=0.0267), yet a significantly lower risk of pseudoarthrosis (22.6% vs 32.3%; RR=0.70 [0.61-0.80]; p<0.001) and dysphagia (12.1% vs 18.8%; RR=0.65 [0.53-0.78]; p<0.001). There was no statistically significant difference in the risk or mean count of oral opioid prescriptions between cohorts (RR=0.96 [0.91-1.01]; 8.4 vs 8.9; p=0.471).
CONCLUSIONS: There appears to be a higher risk of reoperation after HCS with 1L-ACCF compared to that with mACDF in adult patients with DCM. However, HCS with 1L-ACCF was associated with a lower risk of pseudoarthrosis and dysphagia as compared to that of mACDF, with no difference in oral opioid prescriptions. Surgeons can consider these tradeoffs in the complex decision-making process when recommending a surgical approach for DCM.