生物型可吸收颈椎前路钉板系统应用于单节段颈椎病的初步临床研究

The preliminary clinical application of bioresorbable anterior cervical plate system in single-level cervical spondylopathy

中文关键词:  颈椎病  生物型可吸收钉板  钛合金  颈前路减压  伪影  吞咽困难

英文关键词:Cervical spondylosis  Bioresorbable plate  Titanium alloy  Anterior cervical decompression  Imaging artifacts  Dysphagia

中文摘要:

  【摘要】 目的：探讨生物型可吸收颈椎前路钉板系统应用于单节段颈椎病的初步临床效果。方法：选择2013年6月~12月在我院行颈前路椎间盘切除减压植骨融合内固定术（ACDF）治疗的单节段颈椎病患者30例，进行回顾性队列研究，其中15例（神经根型颈椎病5例，脊髓型颈椎病10例）采用传统钛合金钉板系统固定，15例（神经根型颈椎病6例，脊髓型颈椎病9例）采用生物型可吸收钉板系统固定。术前两组患者的年龄、性别、颈椎病分型及病变节段均无统计学差异（P＞0.05）。所有患者术前、术后均行颈椎正侧位+屈伸动力位X线片及颈椎MRI检查。影像学评估其术后颈椎生理曲度及椎间高度变化、植骨融合时间及融合率、有无内固定断裂及移位、是否存在MRI伪影干扰；观察两组患者术后吞咽困难程度及持续时间，采用VAS、JOA评分及JOA评分改善率评估神经功能改善情况。随访时间为术后2个月、6个月、12个月（半年后每月复查颈椎X线片一次，观察是否融合）。结果：钛合金钉板固定组患者术后第1天出现轻度吞咽困难2例，可吸收钉板固定组术后第1天出现轻度吞咽困难1例，均在术后2个月随访时症状消失。术后第1天生物型可吸收钉板固定组颈椎MRI上伪影面积及伪影涉及层数较钛合金钉板系统固定组明显减少（P＜0.05）。钛合金钉板固定组术后12个月时的JOA评分15.9±1.4分，与术前（9.0±1.9分）比较明显提高（P＜0.05），VAS评分由术前的7.5±1.2分减少至0.6±0.7分（P＜0.05）。可吸收钉板固定组术后12个月时的JOA评分为16.1±1.0分，较术前（9.7±1.9分）有显著改善（P＜0.05），VAS评分由术前的6.9±0.9分减少至0.5±0.5分（P＜0.05），两组术后12个月随访时JOA评分改善率无明显差异（P＞0.05）。术后12个月时，钛合金钉板固定组1例未融合，融合率为93.3%，融合时间为7.8±0.4个月（7~8个月）；可吸收钉板固定组15例患者均达到良好的骨融合，融合时间为7.4±0.5个月（7~8个月），两组融合率、融合时间比较均无统计学差异（P＞0.05）。术后12个月时两组患者颈椎生理曲度与椎间高度比较均无统计学差异（P＞0.05），均无内固定断裂及移位的发生。结论：颈前路经椎间隙减压后采用生物型可吸收颈椎前路钉板系统内固定治疗单节段颈椎病，效果满意，可明显减少术后MRI伪影干扰，短期随访不会因钉板降解而导致吞咽困难的发生。

英文摘要:

  【Abstract】 Objectives: To evaluate the outcome of the preliminary clinical application of bioresorbable anterior cervical plate system in single-level cervical spondylopathy. Methods: This was a retrospective cohort study. Thirty patients of cervical spondylopathy from June 2013 to September 2013 underwent sigle-level anterior cervical discectomy and fusion(ACDF). Fifteen cases(5 with cervical spondylotic radiculopathy and 10 with myelopathy) underwent traditional titanium alloy plate system and the other 15 patients(6 with cervical spondylotic radiculopathy and 9 with myelopathy) underwent bioresorbable plate system. There was no significant difference in age, gender, type of cervical spondylosis or level of disease between two groups(P>0.05). X-plain films in anteroposterior, lateral and extension-flexion position and MRI were performed before and after operation. The cervical lordosis and intervertebral disc height were recorded. The fusion time and rates, the fracture and shift of the internal fixation, and the imaging artifacts on MRI were evaluated. The duration of dysphagia was recorded and neurologic function was evaluated by using the visual analogue scale(VAS), the Japanese Orthopeadic Association(JOA) scoring system and JOA recovery rate. The postoperative follow-up time was 2, 6 and 12 months(X-ray was performed once a month to manifest the fusion time). Results: 2 cases presented with dysphagia in titanium group and 1 case in bioresorbable group at 1 day after operation, and all disappeared 2 months after operation. The bioresorbable anterior plate system had small imaging artifacts compared with titanium group. The JOA scores at 12 months after operation significantly increased compared with the preoperative results in both groups(15.9±1.4 ＆ 9.0±1.9 points for titanium group and 16.1±1.0 ＆ 9.7±1.9 points for bioresorbable group, P<0.05 respectively), but the JOA recovery rate was similar(P＞0.05). The VAS had also a significant improvement in two groups(from 7.5±1.2 to 0.6±0.7 points and 6.9±0.9 to 0.5±0.5 points). One patient was noted nonfusion at 12 months after operation in titanium group, with fusion rate of 93.3% and fusion time of 7.8±0.4 months(7-8 months). All the patients in bioresorbable group had a good fusion at last follow-up, with fuison rate of 100% and fusion time of 7.4±0.5 months(7-8 months). There was no significant difference in the fusion rate and fusion time between two groups. There was no significant difference in cervical lordosis and intervertebral height at last follow-up between two groups. There was no fracture or shift of internal fixation in all patients. Conclusions: Bioresorbable anterior cervical plate system for anterior decompression and fusion is reliable, which decreases the imaging artifacts but does not increase the rate of dysphagia due to degradation implant.