颈前路减压零切迹椎间融合器与传统钛板固定融合术后相邻节段退变的比较

Comparison of adjacent segment degeneration after anterior cervical decompression and fusion between Zero-profile interbody fusion device and traditional titanium plate fixation and fusion

中文关键词:  颈前路椎间盘切除融合术  零切迹椎间融合器  钛板  相邻节段退变

英文关键词:Anterior cervical discectomy and fusion  Zero-profile interbody fusion device(Zero-P)  Titanium plate  Adjacent segment degeneration

中文摘要:

  【摘要】 目的：比较颈前路减压零切迹椎间融合器（Zero-P）与传统钛板内固定融合术治疗单/双节段脊髓型颈椎病对术后相邻节段退变的影响。方法：回顾性分析2015年1月~2018年3月采用颈前路减压Zero-P与传统钛板内固定融合术治疗的113例脊髓型颈椎病患者的资料，其中Zero-P组（A组）65例，传统钛板组（B组）48例，A组再分为单节段组（n=44）和双节段组（n=21），B组再分为单节段组（n=28）和双节段组（n=20），4组患者年龄、性别构成比、手术节段均无统计学差异（P＞0.05）。比较两种术式的手术时间、术中出血量，以及4组的术前、末次随访时的日本骨科协会（Japanese Orthopaedie Association，JOA）评分、疼痛视觉模拟评分（visual analog scale，VAS），末次随访时评估患者术后是否出现吞咽困难，并在颈椎侧位X线片上测量术前、术后即刻、末次随访时相邻节段椎间隙高度，评估术前、末次随访时的相邻椎体骨化情况，在颈椎MRI上应用椎间盘Pfirrmann分级评估术前、末次随访时的相邻节段椎间盘退变情况。结果：单节段A组随访时间为18.0±7.9个月，单节段B组为15.8±8.8个月，双节段A组为14.8±6.4个月，双节段B组为15.8±8.2个月，4组间无统计学差异（P＞0.05）。A组手术时间较B组明显缩短（P＜0.05），术中出血量两组无明显差异（P＞0.05）。4组患者末次随访时的JOA评分、VAS评分较术前均有明显改善（P＜0.05），同节段A、B组间比较JOA评分改善率无明显差异（P＞0.05），术前、末次随访时同节段A、B组间比较VAS评分无明显差异（P＞0.05）。双节段B组末次随访时上、下相邻椎间隙高度较术前、术后均有明显下降（P＜0.05），其余3组末次随访时上、下相邻椎间隙高度较术前、术后均无明显差异（P＞0.05）。末次随访时，双节段B组上、下相邻椎间隙高度显著低于双节段A组（P＜0.05），单节段A、B组末次随访时上、下相邻椎间隙高度无明显差异（P＞0.05）。末次随访时，相邻椎体骨化发生率单节段B组（32.14％）与单节段A组（6.82％）比较、双节段B组（40％）与双节段A组（9.52％）比较更高（P＜0.05）。根据Pfirrmann分级，双节段B组（30％）比双节段A组（4.76％）更容易发生相邻节段椎间盘退变（P＜0.05），单节段A、B组末次随访时相邻节段椎间盘退变无明显差异（P＞0.05）；B组中双节段（30％）比单节段（7.14％）更容易发生相邻节段椎间盘退变（P＜0.05），A组中单、双节段末次随访时相邻节段椎间盘退变无明显差异（P＞0.05）。B组的术后吞咽困难发生率均比A组高（P＜0.05）。结论：颈前路单/双节段减压内固定融合手术治疗脊髓型颈椎病中，使用Zero-P与传统钛板内固定融合相比，临床疗效无明显差异，但Zero-P可减少术后相邻节段退变，且在双节段比较中优势更明显。

英文摘要:

  【Abstract】 Objectives: To compare the effects after anterior cervical decompression and fusion between Zero-profile interbody fusion device(Zero-P) and traditional titanium plate fixation and fusion for single/double segment spinal cervical spondylosis on adjacent segment degeneration. Methods: This article retrospectively analyzed 113 patients with cervical spondylotic myelopathy from January 2015 to March 2018 who were treated by using Zero-P(group A, n=65; single-segment of group A, n=44; double-segment of group A, n=21) and traditional titanium plate fixation and fusion(group B, n=48; single-segment of group B, n=28; double-segment of group B, n=20). This article compares the operation time and intraoperative bleeding of the two operation methods. Comparison of JOA score and VAS score in 4 groups of patients were carried out before surgery and at final follow-up. The patients were assessed for dysphagia at final follow-up. Lateral cervical X-ray films were used to measure the height of the intervertebral space of adjacent segments at preoperative, postoperative and the final follow-up, and to evaluate the ossification of adjacent vertebrae before and after the follow-up. On the cervical spine MRI, Pfirrmann classification of the intervertebral disc was used to evaluate the degeneration of intervertebral discs in the adjacent segments before surgery and at the final follow-up. Results: The average follow-up time for single-segment group A, single-segment group B, double-segment group A, and double-segment group B groups were 18.0±7.9 months, 15.8±8.8 months, 14.8±6.4 months, and 15.8±8.2 months respectively. The operation time of group A was significantly shorter than that of group B(P＜0.05). There was no significant difference in intraoperative blood loss between the two groups(P＞0.05). The JOA score and VAS score of the four groups of patients were significantly improved at final follow-up compared with those before surgery. No significant difference in JOA improvement rate between the same segment groups(P＞0.05). No significant difference in VAS scores between the same segment groups at final follow-up(P＞0.05). At final follow-up, the height of the upper and lower adjacent intervertebral space of group B was significantly lower than that before and after surgery(P＜0.05). At final follow-up of the other three groups, the height of the upper and lower adjacent intervertebral space was not significantly different than before and after surgery(P＞0.05). At final follow-up, the height of the upper adjacent intervertebral space of the double-segment group B was significantly lower than that in the double-segment group A and the height of the lower adjacent intervertebral space of the double-segment group B was significantly lower than that in the double-segment group A(P＜0.05). There was no significant difference in the height of the upper and lower adjacent intervertebral spaces between single segment group A and single segment group B at final follow-up(P＞0.05). At final follow-up, for the incidence of ossification of adjacent vertebrae, the single-segment group B(32.14%) was higher than the single-segment group A(6.82%) and the double-segment group B(40%) was higher than the double-segment group A(9.52%)(P＜0.05). According to the Pfirrmann classification, the double-segment group B(30%) was more prone to adjacent segmental disc degeneration than the double-segment group A(4.76%)(P<0.05). There was no significant difference in degeneration of intervertebral disc between single-segment group A and single-segment group B at final follow-up(P＞0.05). The double-segment group B(30%) was more prone to adjacent segmental disc degeneration than the single-segment group B(7.14%)(P<0.05). There was no significant difference in degeneration of intervertebral disc between single-segment group A and double-segment group A at final follow-up(P＞0.05). Regardless of single or double segment, group B had a higher incidence of postoperative dysphagia than group A. Conclusions： In the single-segment and double-segment of ACDF, Zero-P and traditional titanium plate fusion can achieve similar clinical effects, but Zero-P has advantage to reduce degeneration of adjacent segment and has more obvious advantage in the comparison of the two segments.