摘要
目的通过与传统钢板联合融合器(plate-cage construct,PCC)比较,探讨连续三节段颈椎前路椎间盘切除减压植骨融合术(anterior cervical discectomy and fusion,ACDF)中,采用零切迹椎间融合器(zero-profile anchored cage,ZAC)固定的安全性与有效性。方法回顾性分析2020年1月—2022年12月收治且符合选择标准的65例颈椎病患者临床资料。在连续三节段ACDF术中,采用ZAC 35例(ZAC组),PCC 30例(PCC组)。两组患者性别、年龄、身体质量指数、手术节段及术前日本骨科协会(JOA)评分、颈椎功能障碍指数(NDI)、疼痛视觉模拟评分(VAS)、椎前软组织厚度(prevertebral soft tissue thickness,PSTT)、颈椎整体曲度、手术节段曲度等基线资料比较,差异均无统计学意义(P>0.05)。比较两组手术时间、术中出血量、住院时间、临床疗效评价指标(JOA评分、NDI、VAS评分)、影像学评价指标(颈椎整体曲度、手术节段曲度、内植物下沉、手术节段椎间融合、邻近节段退变),以及颈部肿胀(PSTT)和吞咽困难等并发症发生情况。结果两组患者均获随访,随访时间24~39个月,随访时间组间差异无统计学意义(P>0.05)。ZAC组手术时间、术中出血量少于PCC组,住院时间延长,但差异无统计学意义(P>0.05)。两组术后各时间点JOA评分、NDI、VAS评分均较术前改善(P<0.05),且各时间点两组间差异均无统计学意义(P>0.05)。两组术后3 d及3、6个月PSTT均较术前增加(P<0.05),但末次随访时恢复至术前水平(P>0.05);术后3 d和3个月ZAC组PSTT小于PCC组(P<0.05),术后6个月和末次随访时组间差异无统计学意义(P>0.05)。ZAC组术后3 d、3个月吞咽困难发生率低于PCC组(P<0.05),术后6个月及末次随访时组间差异无统计学意义(P>0.05)。两组术后均无声音嘶哑、饮水呛咳、食道损伤、血肿形成等并发症发生。两组颈椎整体曲度和手术节段曲度均较术前改善,在随访过程中均有丢失趋势,ZAC组颈椎整体曲度和手术节段曲度丢失均大于PCC组(P<0.05)。ZAC组内植物下沉发生率高于PCC组(P<0.05),两组椎间融合及邻近节段退变发生率差异无统计学意义(P>0.05)。结论在连续三节段ACDF中,采用ZAC和PCC固定均能获得良好疗效,前者能降低术后吞咽困难发生率,而后者能更好地维持颈椎曲度,降低内植物下沉发生率。
Objective To evaluate the safety and effectiveness of anterior cervical discectomy and fusion(ACDF)by using zero-profile anchored cage(ZAC)in treatment of consecutive three-level cervical spondylosis,by comparing with plate-cage construct(PCC).Methods A clinical data of 65 patients with cervical spondylosis admitted between January 2020 and December 2022 and met the selection criteria was retrospectively analyzed.During consecutive three-level ACDF,35 patients were fixed with ZAC(ZAC group)and 30 patients with PCC(PCC group).There was no significant difference in baseline data between the two groups(P>0.05),including gender,age,body mass index,surgical segment,preoperative Japanese Orthopaedic Association(JOA)score,Neck Disability Index(NDI),visual analogue scale(VAS)score,prevertebral soft tissue thickness(PSTT),cervical lordosis,and surgical segmental angle.The operation time,intraoperative blood loss,hospital stay,clinical indicators(JOA score,NDI,VAS score),and radiological indicators(cervical lordosis,surgical segmental angle,implant subsidence,surgical segment fusion,and adjacent segment degeneration),and the postoperative complications[swelling of the neck(PSTT),dysphagia]were recorded and compared between the two groups.Results Patients in both groups were followed up 24-39 months.There was no significant difference in follow-up duration between the two groups(P>0.05).The operation time and intraoperative blood loss were lower in ZAC group than in PCC group,and the length of hospital stay was longer,but there was no significant difference(P>0.05).At each time point after operation,both groups showed significant improvements in JOA score,VAS score,and NDI compared with preoperative scores(P<0.05),but there was no significant difference between the two groups at each time point after operation(P>0.05).Both groups showed an increase in PSTT at 3 days and 3,6 months after operation compared to preoperative levels(P<0.05),but returned to preoperative levels at last follow-up(P>0.05).The PSTT at 3 days and 3 months after operation were significantly lower in ZAC group than in PCC group(P<0.05),and there was no significant difference between the two groups at 6 months and at last follow-up(P>0.05).The incidences of dysphagia at 3 days and 3 months were significantly lower in ZAC group than in PCC group(P<0.05),while no significant difference was observed at 6 months and last follow-up between the two groups(P>0.05).There was no postoperative complication in both groups including hoarseness,esophageal injury,cough,or hematoma.Both groups showed improvement in cervical lordosis and surgical segmental angle compared to preoperative levels,with a trend of loss during follow-up.The cervical lordosis loss and surgical segmental angle loss were significantly more in the ZAC group than in PCC group(P<0.05).The incidence of implante subsidence was significantly higher in ZAC group than in PCC group(P<0.05).There was no significant difference between the ZAC group and PCC group in the incidences of surgical segment fusion and adjacent segment degeneration(P>0.05).Conclusion In consecutive three-level ACDF,both ZAC and PCC can achieve satisfactory effectiveness.The former can reduce the incidence of postoperative dysphagia,while the latter can better maintain cervical curvature and reduce the incidence of implant subsidence.
作者
勒格石夫
刘知浩
郭灿
刘浩
丁琛
LE Geshifu;LIU Zhihao;GUO Can;LIU Hao;DING Chen(Department of Orthopedics,West China Hospital,Sichuan University,Chengdu Sichuan,610041,P.R.China)
出处
《中国修复重建外科杂志》
北大核心
2025年第2期193-200,共8页
Chinese Journal of Reparative and Reconstructive Surgery
基金
四川省科技计划资助项目(2024YFHZ0163)。
