颈椎前路钩椎关节融合与传统椎骨终板间融合的融合时效比较：一项前瞻性随机对照研究

Comparison of fusion effectiveness between anterior cervical uncovertebral joint fusion and conventional interbody fusion: a prospective, randomized, controlled trial study

中文关键词:  颈椎病  颈椎前路椎间盘切除融合术  钩椎关节融合  融合率  随机对照

英文关键词:Cervical spondylosis  Anterior cervical discectomy and fusion  Uncovertebral joint fusion  Fusion rate  Randomized controlled trial

中文摘要:

  【摘要】 目的：比较颈椎前路融合术（anterior cervical discectomy and fusion，ACDF）中，钩椎关节融合（uncovertebral joint fusion，UJF）与传统椎骨终板间融合（traditional interbody fusion，TIF）的融合时效和安全有效性。方法：2020年5月~2021年6月招募并收治44例单节段颈椎病患者，使用计算机随机数表法分为观察组和对照组，每组22例。观察组施行UJF，对照组施行TIF。两组均取自体髂骨进行植骨融合。通过动力位X线片及CT评估两组术后早期（术后3个月、6个月）融合率。通过日本骨科协会（Japanese Orthopaedic Association，JOA）评分、颈椎功能障碍指数（neck disability index，NDI）、疼痛视觉模拟评分（visual analogue scale，VAS）评估两组的临床疗效。结果：共有40例患者完成了计划随访，UJF组20例，TIF组20例。两组患者年龄、性别比、体重指数（BMI）均无统计学差异（P>0.05）。两组手术时间（133.0±29.4min vs. 124.2±26.3min，P=0.3271）及术中出血量（68.5±48.7ml vs. 83.5±54.5ml，P=0.3645）无显著性差异。UJF组术后3个月、6个月融合率显著性高于TIF组（术后3个月70% vs. 10%，P<0.0001；术后6个月95% vs. 65%，P=0.0177）。两组术后1周、3个月及6个月JOA评分、VAS评分、NDI较术前均有显著性改善（P<0.05），两组之间同时间点比较均无显著性差异（P>0.05）。两组术后均未发生假体下沉和移位、螺钉松动和断裂、手术节段椎间孔再次狭窄等并发症。结论：UJF与TIF治疗单节段颈椎病可同样够获得令人满意的疗效；UJF的早期融合率明显高于TIF, 是一种安全有效的手术方式。

英文摘要:

  【Abstract】 Objectives: To compare the fusion rate and safety effectiveness of uncovertebral joint fusion(UJF) and traditional interbody fusion(TIF) in anterior cervical discectomy and fusion(ACDF). Methods: 44 patients with single level cervical spondylosis were recruited and treated from May 2020 to June 2021. The patients were divided into study group and control group using computerized random number list method with 22 cases in each group. The study group was treated with UJF and the control group was treated with TIF. Autologous iliac bone was taken for bone grafting in both groups. The early postoperative(3 and 6 months after operation) fusion rates of the two groups were evaluated by dynamic X-ray and CT. The clinical outcomes were evaluated by the Japanese Orthopaedic Association(JOA) score, neck disability index(NDI), and visual analogue scale(VAS) score. Results: A total of 40 patients completed the planned follow-up including 20 cases in the study group and 20 cases in the control group. There were no statistical differences in age, gender, and BMI between the two groups of patients. And there were no significant differences in operative time(133.0±29.4min vs. 124.2±26.3min, P=0.3271) and intraoperative bleeding(68.5±48.7ml vs. 83.5±54.5ml, P=0.3645) between the two groups. The fusion rate in UJF group was significantly higher than that in TIF group at 3 and 6 months after operation(3 months: 70% vs. 10%, P<0.0001; 6 months: 95% vs. 65%, P=0.0177). The JOA, VAS and NDI scores of the two groups at one week, three months and six months after operation were significantly improved compared with those before operation. However, there was no significant difference between the two groups at any follow-up time(P>0.05). There were no adverse results such as prosthesis subsidence, displacement, screw loosening, fracture, and restenosis of intervertebral foramen in each group. Conclusions: Both UJF and TIF can obtain satisfactory outcomes in treating single level cervical spondylosis. UJF features significantly higher early fusion rate than TIF, which is a safe and effective surgical method.