【摘要】 目的　对比Hybrid手术[颈椎人工椎间盘置换术（CTDR）联合颈椎前路椎间盘切除融合术（ACDF）]与单纯ACDF治疗颈椎退行性疾病的临床疗效。方法 回顾性分析2010年8月—2019年8月收治的48例双节段及三节段颈椎退行性病变患者临床资料，其中采用Hybrid手术治疗8例（Hybrid组），采用ACDF治疗40例（ACDF组）。应用倾向性评分匹配法（PSM）对Hybrid组和ACDF组患者进行匹配，共8对匹配成功。分别采用t检验、χ²检验及重复测量方差分析比较2组患者基本资料、手术前后颈椎功能障碍指数（NDI）、日本骨科学会（JOA）评分、疼痛视觉模拟量表（VAS）评分及C_2～7活动度（ROM）的变化。结果 匹配后2组术前NDI、JOA评分、VAS评分、C_2～7 ROM差异均无统计学意义（P > 0.05）。2组手术时间、术中出血量、住院时间差异均无统计学意义（P > 0.05）。2组患者术后NDI、JOA评分、VAS评分均较术前明显改善，差异有统计学意义（P < 0.05）；且Hybrid组NDI改善优于ACDF组，差异有统计学意义（P < 0.05）。2组患者术后C_2～7 ROM均较术前下降，差异有统计学意义（P < 0.05）；C_2～7 ROM随访中逐渐增加，且Hybrid组在各随访时间点均优于ACDF组，差异有统计学意义（P < 0.05）。结论 Hybrid手术与ACDF治疗颈椎退行性疾病具有相同的临床效果，Hybrid手术在改善颈部功能和保留颈椎ROM方面优于ACDF。更多还原

【Abstract】 Objective To compare the effects of cervical total disc replacement（CTDR） combined with anterior cervical discectomy and fusion（ACDF） and simple ACDF in the treatment of cervical degenerative diseases.Methods The clinical data of 48 patients with 2 or 3 segments’ cervical degenerative diseases treated from August 2010 to August 2019 were retrospectively analyzed，including 8 cases treated with CTDR combined with ACDF（Hybrid group） and 40 cases treated with ACDF alone（ACDF group）.Eight pairs of patients in Hybrid group and ACDF group were matched successfully by propensity score matching（PSM）.The t test，χ² test and repeated measurement analysis of variance were used to compare the basic data，neck disability index（NDI），Japanese Orthopaedic Association（JOA） score，visual analogue scale（VAS） score and C_2-7 range of motion（ROM） between the 2 groups.Results After matching，there was no significant difference in preoperative NDI，JOA score，VAS score and C_2-7 ROM between the 2 groups（P > 0.05）.There was no significant difference in operation time，intraoperative blood loss and hospital stay between the 2 groups（P > 0.05）.The postoperative JOA score，NDI and VAS scores of the 2 groups were significantly improved compared with those before operation，all with a statistical significance（P < 0.05）；and the improvement of NDI in Hybrid group was better than that in ACDF group，and the difference was statistically significant（P < 0.05）.The postoperative C_2-7 ROM in the 2 groups decreased compared with that before operation，with a statistical significance（P < 0.05）；and C_2-7 ROM increased gradually during follow-up，and was better in Hybrid than in ACDF group at each follow-up time point，all with a statistical significance（P < 0.05）.Conclusions Hybrid surgery has the same clinical effect as ACDF in the treatment of cervical degenerative diseases.Hybrid surgery is superior to ACDF in improving cervical function and preserving cervical ROM.更多还原