锚定式颈椎椎间融合器临床应用中期随访报告

A retrospective mid-term study on the application of anchoring cervical intervertebral fusion cage

中文关键词:  颈椎  锚定式颈椎椎间融合器  脊柱融合术  中期随访

英文关键词:Cervical vertebrae  Anchoring cervical intervertebral fusion cage  Spinal fusion  Mid-term followup

中文摘要:

  【摘要】 目的：观察在颈椎前路椎间盘切除减压后应用锚定式颈椎椎间融合器（anchoring cervical intervertebral fusion cage，ACIFC）植骨融合的中期随访结果。方法：2006年10月~2008年2月收治颈椎疾病患者42例，男22例，女20例；年龄25~69岁，平均48.2岁。颈椎病31例，其中脊髓型14例，神经根型9例，混合型8例；下颈椎不稳症4例；急性颈椎间盘突出症5例；Klippel-Feil综合征2例。均经前路行椎间盘切除减压、ACIFC植骨术，融合节段：单节段27例，双节段14例，三节段1例；共置入ACIFC 58枚，C3/4 11枚，C4/5 13枚，C5/6 18枚，C6/7 14枚，C7/T1 2枚。初次行颈椎手术者40例，颈椎术后再手术2例。术后定期行X线片及MRI复查，判定植骨融合及邻近节段退变情况；采用中华医学会骨科分会（COA）40分法及颈椎残障指数（NDI）评分系统评价患者术前、术后颈脊髓神经功能及生活质量。结果：5例患者术后24h内出现咽部疼痛，经对症治疗于术后1周内症状消失。术后48h内发生轴性症状2例（3.4%），经对症处理术后1周症状明显改善。患者均获随访，随访时间3~4.5年，平均4年。58个椎间隙均获骨性融合，融合时间2.5~6个月，平均3.5个月。术前COA评分30.21±2.69分，术后末次随访时37.18±1.20分，差异有统计学意义（P<0.05），平均改善率71.2%；术前NDI为40.03±3.92，术后末次随访时为29.95±4.51，差异有统计学意义（P<0.05）。术后3.5~4.5年（平均4年）发现融合节段邻近节段退变5例（11.9%），其中融合节段相邻上位椎间盘3例，下位椎间盘2例。结论：在颈椎前路椎间盘切除减压后应用ACIFC行植骨融合，融合率高，轴性症状及邻近节段退变的发生率低，中期随访结果较满意。

英文摘要:

  【Abstract】 Objective：To study the mid-term outcome of clinical application of the anchoring cervical intervertebral fusion cage（ACIFC） following anterior cervical discectomy.Method：42 cases with cervical disorders from October 2006 to February 2008 were reviewed retrospectively.There were 22 males and 20 females with the age of 25-69 years old（mean，48.2 years old）.Of the 31 cases，there were 14 with cervical spondylotic myelopathy，9 with cervical spondylotic radiculopathy，and 8 with mixed type of cervical spondylosis.4 cases suffered from lower cervical instability，5 cases from acute cervical disc herniation and 2 cases from Klippel-Feil syndrome.All cases underwent anterior discectomy，ACIFC fusion.The fusion segments included 27 single-segment，14 two-segments and 1 three-segments.A total of 58 cages were implanted，which included 11 C3/4；13 C4/5；18 C5/6；14 C6/7 and 12 C7/T1.There were 40 primary and 2 revision surgeries.Radiographs were taken routinely to determine the fusion and adjacent segment degeneration（ASD）.The neurofunction and life quality at preoperation and follow-up were evaluated by Chinese Orthopaedic Association（COA） 40 score and neck disability index（NDI）.Result：5 patients were complicated with pharyngis pain in 24 hours after operation，and relieved 7 days later after corresponding intervention.Axial symptoms（AS） were found in 2 patients（3.4%） in 48 hours after operation，and relieved 7 days later.All patients were followed up for an average of 4 years（range，3-4.5 years）.Bony union was achieved in all cases with the mean of 3.5 months（range 2.5-6 months）.Significant difference was noted on COA score between preoperation（30.21±2.69） and final follow-up（37.18±1.20）（P<0.05）.The mean improve rate was 71.2%.And there were significant differences on NDI between preoperation（40.03±3.92） and final follow-up（29.95±4.51）（P<0.05）.5 cases（11.9%） were complicated with ASD in 3.5-4.5 years（mean，4 years） follow-up，which included 3 caudal and 2 distal.Conclusion：A satisfactory mid-term outcome for cervical spinal disease can be obtained by using ACIFC in operation of anterior cervical discectomy with fusion.And the higher fusion rate and lower AS or ASD can be also obtained.