连续双节段前路颈椎间盘切除零切迹系统与钢板联合融合器固定融合治疗颈椎病的疗效比较

A comparison of clinical efficacies of contiguous 2-level anterior cervical discectomy and fusion using zero-profile and cage-and-plate fixation in treating cervical spondylosis

中文关键词:  颈椎病  前路颈椎间盘切除融合术  双节段  零切迹系统  钢板联合融合器  中间椎体塌陷

英文关键词:Cervical spondylosis  Anterior cervical discectomy and fusion  2-level  Zero-profile  Cage-and-plate  Intermediate vertebral body collapse

中文摘要:

  【摘要】 目的：比较连续两节段前路颈椎间盘切除融合（anterior cervical discectomy and fusion，ACDF）应用零切迹系统（zero-profile，ZP）与钢板联合融合器（cage-and-plate，CP）固定治疗颈椎病的临床疗效。方法：回顾性分析2018年3月1日～2021年6月30日因颈椎病于广州中医药大学第一附属医院行连续两节段ACDF应用4钉ZP或CP固定治疗的57例颈椎病患者，其中27例采用ZP固定（ZP组），男12例，女15例，年龄37~80岁（53.0±9.9岁）；30例采用CP固定（CP组），男10例，女20例，年龄39~78岁（57.4±12.4岁）。收集两组患者的体重指数（body mass index，BMI）、L1～L4骨密度（bone mineral density，BMD），术前和术后1个月、3个月、6个月、12个月和末次随访时的颈椎功能障碍指数（neck disability index，NDI）、日本骨科协会（Japanese Orthopaedic Association, JOA）评分、轴性疼痛视觉模拟评分（visual analogue scale，VAS）评分，术前和术后3d、1个月、3个月、6个月、12个月和末次随访时颈椎整体曲度、手术节段曲度，末次随访时椎间融合率及邻近节段退变发生率，随访期间中间椎体塌陷发生率及其他术后并发症发生情况。结果：两组患者手术时年龄、性别、BMI、L1~L4 BMD、随访时间、术前NDI和JOA评分、术前颈椎整体曲度和手术节段曲度等基线指标均无统计学差异（P>0.05）。术后各时间点两组患者NDI、JOA评分、轴性疼痛VAS评分较术前均显著性改善（P<0.001），两组同时间点的JOA评分无统计学差异（P=0.314）；术后3个月、6个月、1年及末次随访时CP组NDI、轴性疼痛VAS评分改善程度优于ZP组（P<0.05）。末次随访时ZP组颈椎整体曲度丢失和手术节段曲度丢失均明显大于CP组（P<0.05）。末次随访时两组椎间融合率及邻近节段退变发生率无显著性差异。随访过程中ZP组出现4例中间椎体塌陷，而CP组未出现，两组间比较有统计学差异（P＜0.05）。结论：在双节段ACDF中，相对于应用ZP固定融合，应用CP能够更好地维持颈椎曲度，避免固定节段中间椎体塌陷，获得更好的临床疗效。

英文摘要:

  【Abstract】 Objectives: To compare the clinical efficacies of zero-profile(ZP) and cage-and-plate(CP) fixation in two contiguous levels of anterior cervical discectomy and fusion(ACDF). Methods: 57 patients with cervical spondylosis treated with 4-pin ZP or CP fixation in contiguous 2-level ACDF between March 1, 2018 and June 30, 2021 in the First Clinical Medical College of Guangzhou University of Chinese Medicine were retrospectively analyzed. Of all the patients, 27 were fixed with ZP(ZP group), including 12 males and 15 females, aged 37-80(53.0±9.9) years; and the other 30 were fixed with CP(CP group), including 10 males and 20 females, aged 39-78(57.4±12.4) years. The body mass index(BMI), L1-4 bone mineral density(BMD), preoperative and postoperative 1, 3, 6 and 12 months, and final follow-up neck disability index(NDI), Japanese Orthopaedic Association(JOA) score, and axial pain visual analogue scale(VAS), and preoperative and postoperative 3d, and 1, 3, 6 and 12 months, and final follow-up cervical curvature, surgical segment curvature, and final follow-up interbody fusion rate and adjacent level degeneration rate, and intermediate vertebral collapse and other postoperative complications during follow-up were collected and compared between the two groups. Results: No significant differences were observed in the baseline data such as age, gender, BMI, L1-4 BMD, follow-up period, preoperative NDI and JOA score, preoperative cervical curvature and surgical segment curvature between the two groups(P>0.05). Postoperative NDI, JOA score, and axial pain VAS score were improved over time in both groups(P＜0.001). There was no statistical difference between the two groups in JOA score at the same time point(P=0.314). At 3 and 6 months, and 1 year and the final follow-up, the improvement of NDI and axial pain VAS scores in the CP group was significantly better than that in the ZP group(P<0.05). At the final follow-up, cervical curvature loss and surgical level curvature loss in the ZP group were significantly greater than those in the CP group(P<0.05), and there were no significant differences in the incidence of interbody fusion rate and adjacent level degeneration rate between the two groups. During the whole follow-up process, there were 4 cases of intermediate vertebral collapse in the ZP group, but none in the CP group, with statistical difference between the two groups(P<0.05). Conclusions: In 2-level ACDF, compared with ZP fixation, the application of CP can better maintain the curvature of cervical spine, avoid intermediate vertebral collapse, and obtain better clinical efficacy.