摘要
目的通过与传统融合器并钛板融合术比较,探索C_4/C_5/C_6/C_7三节段Zero-P融合治疗颈椎退变性疾病的中期临床疗效与影像学变化。方法纳入2009年7月—2013年5月在本院接受C_4/C_5/C_6/C_7颈椎融合手术的患者共72例。其中A组患者应用Zero-P进行融合,共30例;B组用传统融合器加钛板,共42例。两组患者术前各项参数比较差异无统计学意义。于术后2个月、6个月、1年、2年及近期各时间点进行复查随访,比较两组患者日本骨科学会(JOA)评分、颈椎功能障碍指数(NDI)、颈椎曲度、C_(4~7) Cobb角、吞咽困难发生率、融合率、邻近节段退变(ASD)发生率等的差异。结果所有患者随访>2年,随访期间,A组与B组术后JOA评分、NDI、融合率及ASD发生率比较差异均无统计学意义。A组患者术后C_(4~7)Cobb角呈缓慢丢失趋势,在术后2年及末次随访时小于B组(P<0.05)。A组患者术后颈椎曲度呈缓慢丢失趋势,在末次随访时低于B组(P<0.05)。A组患者吞咽困难发生率于术后2个月时低于B组(P<0.05),余随访时间两组差异无统计学意义。结论 Zero-P用于颈椎三节段融合时中期疗效满意、并发症少。其可有效降低术后2个月吞咽困难发生率,但对手术节段Cobb角及颈椎曲度的维持作用较差。
Objective To explore the mid-term surgical outcomes and radiographic changes of C_4/C_5/C_6/C_7 3-level fusion with Zero-P spacer in the treatment of cervical degenerative disease through compared with traditional cage with titanium plate. Methods Totally 72 C_4/C_5/C_6/C_7 cervical fusion patients from July 2009 to May 2013 were included in this study,with 30 patients in group A using Zero-P for fusion,while 42 patients in group B using traditional cage and titanium plate. There was no significant difference in patient's preoperative parameters between 2 groups. The Japanese Orthopedic Association(JOA) score,neck disability index(NDI),cervical curvature,C_(4-7) Cobb's angle,incidence of dysphagia,fusion rate,adjacent segment degeneration rate were compared between 2 groups at 2 months,6 months,1 year,2 years after operation and the final follow-up. Results The JOA score,NDI,fusion rate and adjacent segment degeneration rate showed no statistically significant difference between 2 groups at all observation time points. The C_(4-7) Cobb's angle of group A showed slowly lost trend,and significantly lower than that of group B at postoperative 2 years and final follow-up(P < 0.05). The cervical curvature in group A also showed slowly lost trend,and significantly lower than that of group B only at final follow-up(P < 0.05). The incidence of dysphagia in group A was significantly lower than that of group B(P < 0.05) at postoperative 2 months,but had no significant difference at other follow-up time point. Conclusion Zero-P has a satisfactory mid-term outcomes with fewer complications when it is used in 3-level anterior cervical discectomy and fusion. It can effectively reduce the incidence of dysphagia at 2 months after operation,but it is poor in the maintenance of operated segment Cobb's angle and cervical curvature.
出处
《脊柱外科杂志》
2017年第3期129-133,共5页
Journal of Spinal Surgery
基金
国家自然科学基金(81572194
81371383)
上海市西医引导类项目(16411963900)
关键词
颈椎
颈椎病
椎间盘切除术
脊柱融合术
内固定器
Cervical vertebrae
Cervical spondylosis
Diskectomy
Spinal fusion
Internal fixators
