新型门型钢板在颈前路椎间盘切除减压融合术中应用的临床疗效

Clinical efficacy of a new type of door-shaped steel plate in anterior cervical discectomy and fusion

中文关键词:  颈椎病  颈椎前路椎间盘切除减压融合术  门型钢板  疗效

英文关键词:Cervical spondylosis  Anterior cervical discectomy and fusion  Door-shaped steel plate  Efficacy

中文摘要:

  【摘要】 目的：探讨新型门型钢板在颈椎前路椎间盘切除减压融合术（anterior cervical discectomy and fusion，ACDF）中应用的临床疗效。方法：回顾性分析2020年11月~2022年1月在我院行ACDF治疗的46例单节段颈椎病患者的临床资料，神经根型颈椎病29例，脊髓型颈椎病17例。25例术中采用新型门型钢板固定（观察组），男18例，女7例；年龄42~67岁（58.46±6.04岁）；手术节段C4/5 7例，C5/6 12例，C6/7 6例。21例术中使用Katia颈椎前路内固定系统固定（对照组），男13例，女8例，年龄45~71岁（58.31±5.79岁），手术节段C4/5 5例，C5/6 10例，C6/7 6例。两组患者年龄、性别、病变节段等均无统计学差异（P>0.05）。记录两组患者的术中出血量、手术时间、术后声音嘶哑和吞咽困难等的发生情况；术前、术后3d、术后3个月和末次随访时采用疼痛视觉模拟评分（VAS）、颈椎JOA评分、颈椎功能障碍指数（NDI）进行评定；在术前、术后1周、术后3个月和术后6个月的X线片上测量颈椎Cobb角，并在术后6个月的X线片上观察植骨融合情况。结果：观察组患者的手术时间和术中出血量为108.6±14.0min和52.8±23.0ml，对照组为124.3±14.6min和60.9±18.6ml，观察组手术时间较对照组短（P<0.05），两组患者术中出血量无统计学差异（P>0.05）。观察组术后均未出现声音嘶哑，2例出现吞咽困难；对照组1例出现声音嘶哑，3例患者出现吞咽困难，两组患者术后出现声音嘶哑或者吞咽困难的比例无统计学意义（P>0.05）。46例患者均获得随访，随访时间6~14个月。两组术后3d、3个月和末次随访时的VAS评分、JOA评分和NDI与术前比较均有显著性改善（P<0.05），两组同时间点比较均无统计学差异（P>0.05）。两组术后1周、术后3个月、术后6个月的颈椎Cobb角与术前比较均有显著性改善（P<0.05），两组间同时间点颈椎Cobb角无统计学差异（P>0.05）。观察组术后6个月椎间融合优良21例（84.0%），对照组18例（85.7%），两组椎体融合率无统计学差异（P>0.05）。结论：在ACDF治疗单节段颈椎病中应用新型门型钢板与应用katia颈椎前路内固定系统内固定的临床效果相近，新型门型钢板钉板一体，操作简便，手术时间较短。

英文摘要:

  【Abstract】 Objectives: To investigate the clinical efficacy of a new type of door-shaped steel plate in anterior cervical discectomy and fusion(ACDF). Methods: The clinical data of 46 patients with single-level cervical spondylosis treated with ACDF in our hospital between November 2020 and January 2022 were retrospectively analyzed, including 29 patients of cervical spondylotic radiculopathy and 17 patients of cervical spondylotic myelopathy. Among the patients, 25 were fixed with the new type of door-shaped steel plate(observation group), consisting of 18 males and 7 females, aged 58.46±6.04 years(range, 42-67 years), and the operative segment was C4/5 in 7 cases, C5/6 in 12 cases, and C6/7 in 6 cases; The other 21 patients were treated with Katia anterior cervical internal fixation system(control group), including 13 males and 8 females, aged 58.31±5.79 years(45-71 years), and the operative segment was C4/5 in 5 cases, C5/6 in 10 cases, and C6/7 in 6 cases. There was no significant difference in age, gender, and lesion segment between the two groups(P>0.05). The intraoperative blood loss, operation time, postoperative complications(hoarseness and dysphagia, etc.) of the two groups were recorded. The visual analogue scale(VAS), Japanese Orthopaedic Association(JOA) score of cervical spine, and neck disability index(NDI) before operation, at 3d and 3 months and, the last follow-up were used to evaluate the effectiveness. The cervical Cobb angle was measured on the X-ray films before operation, at 1 week, and 3 and 6 months after operation, and the fusion rate of bone graft was observed on the X-ray film at 6 months after operation. Results: The operation time and intraoperative blood loss were 108.6±14.0min and 52.8±23.0ml in the observation group, and 124.3±14.6min and 60.9±18.6ml in the control group. The operation time in the observation group was shorter than that in the control group(P<0.05), and there was no significant difference in intraoperative blood loss between the two groups(P>0.05). In the observation group, none occurred hoarseness while 2 cases experienced dysphagia after operation; In the control group, 1 patient occurred hoarseness and 3 patients experienced dysphagia after operation. There was no significant difference in the proportion of hoarseness or dysphagia between the two groups(P>0.05). All the 46 patients were followed up for 6-14 months. The VAS score, JOA score, and NDI at 3d and 3 months after operation, and final follow-up were significantly improved when compared with those before operation in the two groups(P<0.05), but there was no significant difference between the two groups at the same time point(P>0.05). The cervical Cobb angles of the two groups at 1 week, 3 months and 6 months after operation were significantly improved when compared with those before operation(P<0.05), but no significant difference was found between the two groups at the same time point(P>0.05). Good intervertebral fusion was observed in 21 cases(84.0%) in the observation group and 18 cases(85.7%) in the control group at 6 months after operation, with no significant difference between the two groups(P>0.05). Conclusions: In the treatment of single-level cervical spondylosis with ACDF, the new type of door-shaped steel plate and Katia anterior cervical internal fixation system have similar clinical effects, but with the integration of screw, the new type of door-shaped steel plate is easy to operate and shorter in operation time.