颈前路减压零切迹椎间植骨融合内固定系统治疗颈椎病的早期疗效分析

Early outcome of anterior cervical discectomy and fusion using a Zero-profile interbody fusion and fixation device for cervical spondylosis

中文关键词:  颈椎病  颈前路椎间盘切除融合术  零切迹椎间植骨融合内固定系统  疗效  吞咽不适

英文关键词:Cervical spondylosis  Anterior cervical discectomy and fusion  Zero-profile interbody fusion and fixation device  Outcome  Dysphagia

中文摘要:

  【摘要】 目的：分析颈前路减压零切迹椎间植骨融合内固定系统（Zero-P）治疗颈椎病的早期疗效。方法：2010年6月~10月39例颈椎病患者接受颈前路减压Zero-P植骨内固定手术，患者年龄33~71岁，平均50.3岁。神经根型颈椎病8例，脊髓型31例；单间隙14例，2个间隙18例，3个间隙7例。共置入Zero-P 71枚，C3/4、C4/5、C5/6、C6/7椎间隙置入Zero-P分别为8、19、30、14枚。术前、术后2个月及12个月对神经根型颈椎病患者行VAS评分、脊髓型颈椎病患者行JOA评分，在颈椎中立侧位X线片上测量颈椎Cobb角（C2和C7椎体后缘切线的夹角），观察术后吞咽不适的发生率以及症状持续时间。根据术后伸屈侧位X线片观察手术间隙有无异常活动。结果：手术时间48~130min，平均86min；术中出血量40~310ml，平均110ml。14例患者术后1周内出现吞咽不适，其中13例术后2个月内症状消失，1例（2.6%）症状持续至术后4个月消失。随访12~16个月，平均14.6个月。神经根型颈椎病患者术后2个月、12个月时的VAS评分分别为1.5±0.8分、1.3±0.9分，均低于术前的7.3±1.3分（P<0.05）。脊髓型颈椎病患者术后2个月、12个月时的JOA评分分别为14.6±1.1分、15.0±1.2分，均高于术前的9.7±1.7分（P<0.05）。术后2个月及12个月颈椎Cobb角分别为18.4°±9.6°、17.8°±9.2°，大于术前的9.0°±10.0°（P<0.05）。术后12个月时的VAS评分、JOA评分和颈椎Cobb角与术后2个月比较无显著性差异（P>0.05）。随访期间手术间隙无异常活动，内置物无移位。结论：颈前路减压Zero-P植骨内固定治疗颈椎病的早期疗效满意，稳定性可靠，可重建颈椎曲度，术后慢性吞咽不适发生率低。

英文摘要:

  【Abstract】 Objectives： To analyze the early outcome of anterior cervical discectomy and fusion(ACDF) using a Zero-profile interbody fusion and fixation device(Zero-P) for interbody fusion in the treatment of cervical spondylosis. Methods： The study enrolled thirty-nine patients who underwent ACDF with Zero-P between June and October 2010. The cohort had a mean age of 50.3 years(range 33-71 years). There were 8 patients with radiculopathy and 31 patients with myelopathy. A total of 71 Zero-Ps were implanted, distributed as 14 patients with monosegmental, 18 patients with bisegmental, and 7 patients with trisegmental disease. The number of Zero-Ps implanted in the C3/4, C4/5, C5/6, C6/7 was 8, 19, 30, and 14 respectively. Clinical outcome was evaluated using Visual Analog Scales(VAS) score for radiculopathy, and Japanese Orthopaedic Association(JOA) score for myelopathy before operation and at 2 months′ and 12 months′ follow-up, while the cervical Cobb angle was measured by the tangent of the posterior body line of C2 and C7 on the lateral X-ray plain. The incidence and duration of dysphagia were also recorded. The abnormal activity at the surgical segment was observed by the extension and flexion lateral X-ray plain. Results： The operation time was between 48 and 130min(averagely 86min), and blood loss was between 40 and 310ml(averagely 110ml). Among 14 patients who had dysphagia within 1 week after operation, 13 patients′ symptom disappeared at 2 months′ follow-up， only 1(2.6%) patient′s symptom lasted for 4 months. All patients were followed up for an average of 14.6 months(range, 12 and 16 months）. Compared to preoperation, the VAS score reduced significantly(P<0.05) from preoperative 7.3±1.3 to 1.5±0.8 of 2 months′ follow-up and 1.3±0.9 of 12 months′ follow-up, the JOA score increased significantly(P<0.05) from preoperative 9.7±1.7 to 14.6±1.1 of 2 months′ follow-up and 15.0±1.2 of 12 months′ follow-up, and the cervical Cobb angle improved significantly(P<0.05) from preoperative 9.0°±10.0° to 18.4°±9.6° of 2 months′ follow-up and 17.8°±9.2° of 12 months′ follow-up. During the follow-up, no abnormal activity at the surgical segment and implant displacement were observed. Conclusions： The early outcome of ACDF using a Zero-profile interbody fusion and fixation device in the treatment of cervical spondylosis is satisfactomy and reliable, and can restore the cervical alignment. The incidence of postoperative dysphagia is low.