摘要
目的:探讨零切迹椎间融合器与钛板椎间融合器(cage)内固定治疗颈前路椎间盘切除融合术后症状性邻近节段退变的临床疗效。方法:回顾性分析2014年10月至2019年6月行颈前路椎间盘切除融合术后因出现症状性邻近节段退变而再次行手术治疗的患者26例,男17例,女9例;年龄(54.15±8.60)岁(范围41~68岁)。责任节段包括C 2,3 1例,C 3,4 3例,C 4,5 9例,C 5,6 6例,C 6,7 7例。采用颈前路减压零切迹椎间融合固定术(零切迹组)12例,颈前路减压钛板cage内固定术(钛板组)14例。比较两组手术时间、术中出血量、日本骨科学会(Japanese Orthopaedic Association Scores,JOA)评分、疼痛视觉模拟评分(visual analogue scale,VAS)、颈椎功能障碍指数(neck disability index,NDI)、吞咽困难Bazaz分级、植骨融合Eck等级、C 2-C 7 Cobb角及并发症发生率。 结果:术后随访(33.38±21.26)个月(范围12~71个月)。零切迹组手术时间为(95.83±5.47) min(范围89~105 min);较钛板组的(121.28±8.24) min(范围106~131 min)短,差异有统计学意义( t=9.102, P=0.000)。零切迹组术后1个月吞咽困难Bazaz分级较钛板组轻,差异有统计学意义( W=126.000, P=0.022);术后3个月两组均无残留吞咽困难患者。零切迹组JOA评分由术前(9.50±1.31)分增至术后3个月(14.00±1.21)分、末次随访时(14.33±0.78)分,钛板组由术前(9.14±1.79)分增至术后3个月(14.29±1.07)分、末次随访时(14.71±0.73)分,两组手术前后的差异均有统计学意义( F=247.343,116.448, P=0.000)。零切迹组VAS评分由术前(5.33±1.67)分降至术后3个月(1.42±0.51)分、末次随访时(0.83±0.72)分,钛板组由术前(5.43±1.55)分降至术后3个月(1.86±0.66)分、末次随访时(1.43±0.76)分,两组手术前后的差异均有统计学意义( F=176.355,88.500, P=0.000)。零切迹组NDI由术前43.62%±9.31%降至术后3个月15.38%±3.23%、末次随访时14.99%±3.26%,钛板组由术前43.76%±8.47%降至术后3个月14.35%±4.61%,末次随访时14.22%±4.59%,两组手术前后的差异均有统计学意义( F=154.358,99.307, P=0.000)。零切迹组C 2-C 7 Cobb角由术前8.26°±2.92°改善至术后3个月15.69°±4.06°、末次随访时14.80°±4.18°,钛板组由术前5.53°±9.04°改善至术后3个月15.51°±6.75°、末次随访时14.68°±6.89°,两组手术前后的差异均有统计学意义( F=112.014,53.315, P=0.000)。随访期间未发生螺钉松动、断裂及食管损伤。 结论:颈前路减压零切迹椎间融合内固定术和钛板cage内固定术治疗症状性邻近节段退变均能取得良好的临床疗效,并在一定程度上恢复及维持颈椎生理曲度。零切迹椎间融合在缩短手术时间、减少软组织损伤及术后早期吞咽困难方面更具优势。
Objective To compare the clinical effects of Zero-profile(Zero-p)intervertebral fusion and titanium plate combined with cage fusion in treating symptomatic adjacent segment disease(ASD)after anterior cervical discectomy and fusion(ACDF).Methods Retrospective analysis was performed on 26 patients who underwent ACDF and readmission due to concurrent symptomatic ASD from October 2014 to June 2019.There were 17 males and 9 females,aged 54.15±8.60(range 41-68)years.The index level included C2,31 case,C3,43 cases,C4,59 cases,C5,66 cases,C6,77 cases.Twelve cases underwent anterior cervical decompression with Zero-p intervertebral fusion and fixation(Zero-p group),while 14 cases underwent anterior cervical decompression with titanium plate combined with cage fusion and fixation(titanium plate group).The following parameters,including operative duration,intraoperative blood loss,Japanese Orthopaedic Association(JOA)score,visual analogue score(VAS),neck disability index(NDI),dysphagia Bazaz grade,bone graft fusion Eck grade,C2-C7 Cobb angle,and related complications,were compared between the two groups.Results The operation was performed successfully in all the patients.The patients were followed up for averagely 33.38±21.26(range 12-71)months.The operation duration was 95.83±5.47(range 89-105)min in the Zero-p group,which was shorter than 121.28±8.24(range 106-131)min in the titanium plate group.The Bazaz classification of dysphagia in the Zero-p group was superior to the titanium plate group at 1 month after operation(W=126.00,P=0.022).Neither group had dysphagia 3 months after surgery.The JOA score increased from preoperative 9.50±1.31 to 14.33±0.78,and VAS decreased from 5.33±1.67 to 0.83±0.72 in the Zero-p group.The NDI decreased from 43.62%±9.31%to 14.99%±3.26%,and C2-C7 Cobb changed from 8.26°±2.92°to 14.80°±4.18°in the Zero-p group.The JOA score increased from preoperative 9.14±1.79 to 14.71±0.73,and VAS decreased from 5.43±1.55 to 1.43±0.76 in the titanium plate group.The NDI decreased from 43.76%±8.47%to 14.22%±4.59%,and C2-C7 Cobb changed from 5.53°±9.04°to 14.68°±6.89°in the titanium plate group.No complication,such as screw loosening or breakage or esophageal injury,occurred during the follow-up.Conclusion Both methods can achieve good clinical effects in treating symptomatic ASD and can restore the physiological curvature of the cervical spine to a certain extent.Furthermore,the advantages of Zero-p intervertebral fusion include shorter operation duration,reducing soft tissue injury and less postoperative dysphagia.
作者
陈扬扬
皮国富
孙建广
黄世磊
韩钰
李峰
李承祥
孙星
Chen Yangyang;Pi Guofu;Sun Jianguang;Huang Shilei;Han Yu;Li Feng;Li Chengxiang;Sun Xing(Department of Orthopaedics,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China)
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2020年第22期1522-1530,共9页
Chinese Journal of Orthopaedics
关键词
颈椎
脊髓压迫症
脊柱融合术
再手术
Cervical vertebrae
Spinal cord compression
Spinal fusion
Reoperation
