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目的:探讨颈椎前路减压融合术（anterior cervical decompression and fusion，ACDF）治疗的节段数量对寰枢椎的影响及相关因素分析。方法:连续性收集并回顾性分析2016年12月至2018年12月共126例接受ACDF手术的颈椎病患者资料，其中男59例，女67例，年龄（54.3±8.4）岁（范围：40~79岁）。126例根据颈椎病的类型分为：神经根型60例，脊髓型41例和混合型25例。根据手术节段数量分为：单节段手术组20例；双节段手术组45例；多节段手术组61例，包括3节段51例、4节段10例。分别于术前1周、术后3个月及术后1年对所有患者行颈椎标准侧位、过屈过伸位X线片检查，并分别进行临床疗效评价及颈椎矢状位参数测量，其中临床疗效评价包括日本骨科学会评分（Japanese Orthopaedic Association，JOA）、疼痛视觉模拟评分（visual analogue scale，VAS）、颈椎功能障碍指数（neck disability index，NDI）。颈椎矢状位参数包括Cn 2-7、Cn 0-1、Cn 1-2曲度和活动度以及枢椎斜坡角度（Cn 2Slope）。n 结果:126例随访时间（25.6±7.2）个月（范围：14~38个月）。单节段、双节段和多节段组手术时间分别为（86.4±15.5）、（117.6±15.6）、（170.2±28.7）min，术中出血量分别为（16.5±5.2）、（37.2±30.5）、（63.4±41.5）ml，差异均有统计学意义（n P0.05）。多节段组术后寰枕关节活动度由术前11.5°±6.1°增至术后3个月的16.1°±13.9°和术后1年的15.3°±4.8°,上颈椎曲度、枢椎斜坡角度分别由术前21.0°±7.6°、6.1°±6.7°减至术后3月18.6°±7.7°、4.3°±6.9°和术后1年19.7°±7.2°、5.6°±6.3°,差异均有统计学意义（n P0.05）。n 结论:单、双节段ACDF对于前凸曲度维持效果更好，且对上颈椎无显著影响，但多节段融合会影响前凸曲度维持、限制颈椎活动范围，引起寰枕关节应力及活动度增加、退变风险增大。“,”Objective:To explore sagittal parameters change of upper cervical spine after anterior cervical decompression and fusion (ACDF) and analyze the influential factors by comparison between single-, double- and multi-level surgery.Methods:In this retrospective study, 126 patients (include 60 patients with radiculopathy, 41 patients with myelopathy and 25 patients with myeloradiculopathy) who underwent ACDF between December 2016 and December 2018, were followed up at least 1year ranged from14 to 38 months, with the average of 25.6±7.2 months. 20 patients were operated by single-level ACDF, 45 patients were operated by double-level ACDF and 61 patients were operated by 3- or 4-level ACDF. Standing radiographs of cervical spine and the flexion and extension cervical X-rays were obtained in all patients at 1week before, 3 months after and 1year after operation. The Japanese Orthopaedic Association (JOA) Scores, visual analogue scale (VAS) and neck disability index (NDI) were used to evaluate the clinical effectiveness. Cervical sagittal parameters were assessed with the following parameters: the platform angle of axis (C2Slope), the cobb angle and the range of motion (ROM) of C2-7, C0-1 and C1-2.Results:All the patients obtained satisfactory clinical effects. The mean operative time of single-, double- and multi-level group were 86.4±15.5 min, 117.6±15.6 min and 170.2±28.7 min, respectively. The intraoperative blood loss of 3 groups were 16.5±5.2 ml, 37.2±30.5 ml and 63.4±41.5 ml, respectively. There was statistically significant difference between the 3 groups (n P0.05). In the multi-level group, the ROM of atlantooccipital joint (C0-1) increased significantly from 11.5°±6.1° before operation to 16.1°±13.9° 3 months and 15.3°±4.8° 1 year after operation (n P<0.05). The cobb angle of upper cervical spine and C2Slpoe was decreased significantly from 21.0°±7.6°, 6.1°±6.7° before operation to 18.6°±7.7°, 4.3°±6.9° 3 months and 19.7°±7.2°, 5.6°±6.3° 1 year after operation respectively (n P0.05).n Conclusion:Single- and double-level surgery makes a better ability of preserving the restoration of cervical lordosis, with little impact on the upper cervical spine, meanwhile multi-level fusion shows a negative influence on the restoration and limits the range of motion, also increases risk of surgical operation and degeneration of the atlantooccipital joint, with the increased stress distribution and range of motion.