Zero-P椎间融合器在颈胸交界处椎间盘突出症治疗中的应用效果

Clinical study of Zero-P intervertebral fusion device in the treatment of cervicothoracic junction disc herniation

中文关键词:  颈胸交界处  椎间盘突出症  Zero-P椎间融合器  前路减压

英文关键词:Cervicothoracic junction  Disc herniation  Zero-P intervertebral fusion device  Anterior decompression

中文摘要:

  【摘要】 目的:探讨Zero-P椎间融合器在颈胸交界处椎间盘突出症颈前路手术治疗中的应用及疗效。方法：2012年8月～2015年8月，我院采用颈前路减压结合Zero-P椎间融合器置入治疗的颈胸交界处椎间盘突出症患者9例，其中男5例，女4例，年龄34～69岁，平均49.65±5.73岁；病程3～18个月，平均5.37±3.63个月。CT及MRI均显示明显的椎间盘突出及脊髓受压，MRI显示多节段颈椎椎间盘突出5例（2例为C4/5、C7/T1，2例为C6/7、C7/T1，1例为C3/4、C4/5、C7/T1），单节段颈椎椎间盘突出4例（C7/T1）。术前通过X线、CT和MRI进行评估，所有入选的病例其胸骨切迹水平所对的椎体高度均位于突出间隙下位椎体以下。采用日本骨科协会（Japanese Orthopedic Association，JOA）评分法、 疼痛视觉模拟评分（visual analogue scale，VAS）和颈椎功能障碍指数（neck disability index，NDI）评价临床治疗效果，术后常规影像学检查评估植骨愈合情况。结果：全部患者手术顺利，所有突出节段均获得良好减压、融合。术中减压及内固定放置顺利，均未出现脊髓、硬膜损伤，未出现脑脊液漏、感染等严重并发症。随访时间平均24个月（12～36个月），中位随访时间为25个月。患者的VAS及NDI术前分别为7.06±1.64分和43.27±4.53分，术后12个月时分别为2.02±1.38分和8.64±2.37分，均较术前明显改善（P＜0.05）；患者术前JOA评分为6.94±1.57分，术后12个月随访时改善为13.14±1.62分，差异有统计学意义（P<0.05）。在术后随访颈椎X线片中未发现内置物沉降、螺钉松动、断裂和移位等并发症的发生。所有患者在末次随访时均达骨性融合。结论：采用颈前路减压结合Zero-P椎间融合器置入治疗颈胸交界处椎间盘突出症能够获得良好的减压和固定，获得满意的临床效果。

英文摘要:

  【Abstract】 Objectives: To explore the application and efficacy of Zero-P internal fusion device in anterior cervicothoracic junction surgery. Methods: 9 patients in total with cervicothoracic junction disc herniation treated with Zero-P internal fusion device from August 2012 to August 2015 in our hospital were reviewed. There were 4 females and 5 males. The average age was 49.65±5.73 years old(range, 34-69 years). The average course of disease was 5.37±3.63 month(range, 3-18 months). CT and MRI showed that there were multi-segmental intervertebral disc herniation and compression of spinal cord evidently in 5 patients(2 patients located in C4/5 and C7/T1; 2 patients located in C6/7 and C7/T1; and one patient located in C3/4, C4/5 and C7/T1). Four patients were only affected in a single segment(C7/T1). Preoperative X-ray, CT and MRI showed that all patients′ sternal notches were below the affected level vertically. The effect of clinical treatments were evaluated by Japanese Orthopedic Association(JOA) score, visual analogue scale(VAS) and neck disability index(NDI). Bone graft fusion was evaluated by postoperative routine imaging examination. Results: All surgeries were performed successfully and the involved segaments were decompressed thoroughly. The decompression and implantation were performed smoothly. There was no severe intraoperative or postoperative complication, such as injury of spinal cord or dura, leakage of cerebrospinal fluid or infection. The average follow-up period was 24 months(range, 12－36 months) with a median of 25 months. The VAS was improved from preoperative 7.06±1.64 to 2.02±1.38 at 12 months after surgery. The NDI was improved from preoperative 43.27±4.53 to 8.64±2.37 at 12 months after surgery. The JOA score was improved from preoperative 6.94±1.57 to 13.14±1.62 at 12 months after surgery, the difference was statistically significant(P<0.05). There was no postoperative complications such as the subsidence, bolt loose, breakage or relocation of implants in X-rays during follow-up. All patients achieved bony fusion at final follow-up. Conclusions: The application of anterior cervical decompression combined with Zero-P intervertebral fusion device for the treatment of cervicothoracic junction disc herniation will come to an ideal decompression and fixation with a satisfactory clinical result.