颈前路减压Zero-P融合固定术后椎间隙高度变化对临床疗效和影像学参数的影响

Impact of the change of intervertebral height after anterior cervical discectomy and fusion with Zero-Profile implant system on clinical outcomes and imaging parameters

中文关键词:  颈椎病  颈前路椎间盘切除融合术  Zero-P椎间融合固定系统  椎间隙高度

英文关键词:Cervical spondylosis  Anterior cervical discectomy and fusion  Zero-Profile implant system  Intervertebral height

中文摘要:

  【摘要】　目的：分析颈前路减压Zero-P融合固定术后椎间隙高度（intervertebral height，IH）变化对临床疗效和影像学参数的影响。方法：收集2014年5月～2017年12月在我院行颈前路减压Zero-P融合固定术且随访时间1年以上的123例脊髓型和神经根型颈椎病患者的资料。记录术前、术后1周及末次随访时的手术节段IH，并按术后平均IH变化值（术后1周IH与末次随访的差值）将所有患者分为IH维持组（IH变化值<平均IH变化值）和IH丢失组（IH变化值≥平均IH变化值）。比较两组患者的性别、年龄、手术节段，术前、术后1周及末次随访时的日本骨科学会（Japanese Orthopedics Association，JOA）颈椎功能评分、颈痛视觉模拟评分（visual analogue score，VAS）、颈椎功能障碍指数（neck disability index，NDI）、C2-7 Cobb角及手术节段曲度，术后3周内的吞咽困难发生率，术后3个月、6个月及末次随访的融合率及末次随访时的邻近节段退变（adjacent segment degeneration，ASD）发生率。两组间定量变量的差异采用独立样本t检验，定性变量差异进行卡方检验。结果：根据所有患者术后平均IH变化值（2.08±0.94mm），将123例患者分为2组，其中IH维持组64例，随访时间为15.95±3.39个月；IH丢失组59例，随访时间为16.95±2.87个月。两组的性别、年龄、手术节段及随访时间均无统计学差异（P>0.05），术前、术后1周及末次随访时的JOA评分、VAS评分、NDI、C2-7 Cobb角和手术节段曲度两组间比较均无统计学差异（P>0.05），吞咽困难发生率及末次随访时的融合率两组间比较均无统计学差异（P>0.05）。IH维持组术前IH为5.65±1.69mm，术后1周为8.33±0.78mm，末次随访为6.89±0.98mm，平均变化量为1.44±0.79mm；IH丢失组术前IH为5.31±1.58mm，术后1周为8.25±0.76mm，末次随访为5.50±1.01mm，平均变化量为2.75±0.52mm。IH维持组末次随访时IH和IH变化值显著高于IH丢失组（P<0.001）。术后3个月时IH维持组融合率为64.06%，IH丢失组为42.37％（P=0.019）；术后6个月时IH维持组融合率为81.25%，IH丢失组为54.24%（P=0.002）。末次随访时IH维持组下邻近节段退变发生率为12.5%，显著低于IH丢失组的28.81%（P=0.027）。IH维持组假体下沉发生率为3.13%，显著低于IH丢失组的13.56%（P=0.047）。结论：颈前路减压Zero-P融合固定术后手术节段IH丢失发生率较高；若IH丢失≥2mm可能会降低术后早期融合率，并增加ASD及假体下沉等并发症的发生率。

英文摘要:

  【Abstract】 Objectives: To analyze the effect of changes in intervertebral height(IH) of surgical level on clinical outcomes and imaging parameters after anterior cervical decompression and fusion with the Zero-Profile implant system(Zero-P). Methods: The data of 123 patients with cervical spondylosis of cervical myelopathy or radiculopathy who underwent anterior cervical decompression and fusion with the Zero-P in our hospital from May 2014 to December 2017 and were followed up for at least 1 year were retrospectively analyzed. The IH of operative segment before surgery, at 1 week after surgery and at final follow-up was recorded, and according to the mean IH change value after surgery(difference between IH at 1 week after surgery and final follow-up) the patients were divided into IH maintaining group (IH change0.05), nor was there significant difference between the two groups in preoperative, postoperative 1 week, and final follow-up JOA scores, VAS, NDI, C2-C7 Cobb angle, or surgical segment curvature(P>0.05). Besides, no significant difference was found in dysphagia incidence or final follow-up fusion rate between the two groups(P>0.05). In the IH maintaining group, the IH was 5.65±1.69mm at preoperation, 8.33±0.78mm at 1 week after surgery, and 6.89±0.98mm at the last follow-up, with a mean change of 1.44±0.79mm. In the IH loss group, IH was 5.31±1.58mm preoperatively, 8.25±0.76mm 1 week postoperatively, and 5.50±1.01mm at the last follow-up, with a mean change of 2.75±0.52mm. The IH and IH change at the last follow-up were significantly higher in the IH maintaining group than those in the IH loss group(P<0.001). The fusion rate was 64.06% in the IH maintaining group and 42.37% in the IH loss group at 3 months postoperatively(P=0.019), and 81.25% in the IH maintaining group and 54.24% in the IH loss group at 6 months postoperatively(P=0.002). At the final follow-up, the inferior ASD incidence was 12.5% in the IH maintaining group, which was significantly lower than the 28.81% in the IH loss group(P=0.027). In addition, the incidence of implant subsidence was significantly lower in the IH maintaining group(3.13%) than that in the IH loss group(13.56%)(P=0.047). Conclusions: The incidence of IH loss of operative segements after anterior cervical decompression and fusion with Zero-P implant system is high, and the early postoperative fusion rate may decrease and the incidence of complications such as ASD and prosthesis subsidence may increase if IH loss ≥2mm.