应用新型Peek Prevail椎间融合内固定系统治疗颈椎病的近期疗效观察

The short-term outcomes of Peek Prevail cervical interbody device in ACDF procedure for cervical spondylosis

中文关键词:  颈椎病  颈前路椎间盘切除减压融合术  Peek Prevail

英文关键词:Cervical spondylosis  Anterior cervical discectomy and fusion  Peek Prevail

中文摘要:

  【摘要】 目的：探讨颈椎前路椎间盘切除减压椎间融合内固定术中应用新型Peek Prevail椎间融合内固定系统治疗颈椎病的近期疗效。方法：2014年7月～2014年9月应用Peek Prevail椎间融合内固定系统行颈椎前路椎间盘切除减压椎间融合内固定术治疗颈椎病患者32例，均为单节段融合，其中脊髓型14例，神经根型11例，混合型7例；男18例，女14例；平均年龄55.3±3.4岁（34~64岁）。采用Bazaz吞咽困难评价标准、Park邻近节段骨化分级标准分别评估术后吞咽困难和邻近节段骨化发生情况；采用疼痛视觉模拟评分（VAS）、日本骨科学会评分（JOA）、颈椎残障指数评分（NDI）对患者术前术后脊髓神经功能、生活质量进行评估；术后定期行颈椎X线、CT、MRI检查观察颈椎曲度、内固定状态、植骨融合等情况。结果：全部患者获得随访，随访时间6～7个月，平均6.5±0.7个月。手术时间平均59.0±10.5min，术中出血量平均37.6±18.4ml。1例患者（3.1％）术后6h出现脊髓缺血再灌注损伤表现；3例患者（9.4%）术后36h逐渐出现不同程度吞咽困难，2例轻度，1例中度；均经对症处理后症状消失或明显改善。所有患者术后神经功能及临床症状均得到改善，VAS评分术前为7.5±1.7分，术后6个月时改善为2.5±1.2分（P＜0.05）；NDI评分术前为43.3±3.6分，术后6个月时改善为10.7±2.9分（P＜0.05）；JOA评分术前为9.43±2.55分，术后6个月时改善为16.07±1.02分（P＜0.05）；颈椎曲度术前为-14.30°±1.9°，术后6个月时改善为17.12°±1.4°（P＜0.05）。随访期间未见植骨不融合、融合器下沉、邻近节段骨化及内固定松动等并发症。结论：颈前路椎间盘切除减压植骨融合内固定术中应用Peek Prevail椎间融合内固定系统治疗颈椎病具有操作简单、出血少、手术时间短、并发症少、吞咽困难发生率低的优点，近期临床疗效满意。

英文摘要:

  【Abstract】 Objectives: To observe the short-term outcomes of Peek Prevail cervical interbody device in anterior cervical discectomy and fusion(ACDF) procedure for cervical spondylosis. Methods: From July 2014 to September 2014, 32 patients with cervical spondylosis who underwent Peek Prevail cervical interbody device in ACDF procedure were included in the study. All patients underwent single segmental fusion, among whom 14 cases were with cervical spondylotic myelopathy, 11 cases were with cervical spondylotic radiculopathy, 7 cases were mixed type. There were 18 males and 14 females with a mean age of 55.3±3.4 years old． Postoperative dysphagia and adjacent-level ossification were evaluated respectively by the Bazaz dysphagia score system and the Park adjacent-level ossification score. X-rays, CT and MRI for cervical spine were taken to assess the cervical curvature, the graft fusion and internal fixation. Neurologic function and clinical results were assessed by using visual analogue scale(VAS), Japanese Orthopaedic Association(JOA) score and neck disability index(NDI). Results: All patients were followed up for 6 to 7 months with an average of 6．5±0.7 months. The average operation time was 59.0±10.5min and the average intraoperative blood loss was 37.6±18.4ml. There were 3 patients(9.4%) complaining of dysphagia at 36 hours after surgery, 1 case(3.1%) suffered from spinal cord ischemia reperfusion injury at 6 hours after surgery, all the symptoms of the 4 cases disappeared or improved obviously after symptomatic treatment． All the patients had a satisfactory improvement of neurologic outcome． VAS score improved from 7.5±1.7 preoperatively to 2.5±1.2 at 6 months after surgery(P＜0.05), JOA score improved from 9.43±2.55 preoperatively to 16.07±1.02 at 6 months after surgery(P＜0.05), NDI score improved from 43.3±3.6 preoperatively to 10.7±2.9 at 6 months after surgery(P＜0.05), cervical curvature improved from -14.30°±1.9° preoperatively to 17.12°±1.4° at 6 months after surgery(P＜0.05). No failure of fusion, cage subsidence, adjacent-level ossification and internal fixation related complications were observed during follow-up． Conclusions： Peek Prevail cervical interbody device in ACDF procedure for cervical spondylosis shows an excellent early clinical outcome. The advantages of the device are convenient procedure, less bleeding, short operation time, lower incidence of postoperative dysphagia, satisfactory clinical outcome.