零切迹颈椎前路椎间融合固定系统治疗单节段颈椎间盘突出症  

Zero profile implant for anterior cervical discectomy and fusion in treating single cervical disc herniation

作　　者：杨迪[1] 邵海宇[1] 张骏[1] 李晓林[1] 金永明[1] 陈锦平[1] 黄亚增[1] 

机构地区：[1]浙江省人民医院骨科脊柱外科中心,浙江杭州310014

出　　处：《中国骨伤》2014年第5期379-384,共6页China Journal of Orthopaedics and Traumatology

摘　　要：目的：探讨应用零切迹颈椎前路椎闯融合固定系统手术治疗单节段颈椎间盘突出症的临床疗效及安全性。方法：2011年8月至2012年6月应用零切迹颈椎前路椎间融合固定系统手术治疗30例单节段颈椎间盘突出症患者，男18例，女12例；年龄36~68岁，平均55．3岁。观察患者的术后吞咽困难发生率、椎间隙高度变化及植骨融合情况，并分别采用JOA评分和Odom评级方法对脊髓神经功能和疗效进行评定。结果：所有患者获得随访，时间12～24个月，平均15．9个月。术中出血量为70-120m1，平均（85．3±14．2）ml；手术时间70~120min，平均（90．0±12．8）min。JOA评分由术前的8．72±2．36（5．0-13．0分）上升至术后3个月的14．72±1．66（11．5~17．0分）及术后1年15．65±1．03（13．5-17．0分）。术后1年，按Odom评级法评定临床疗效，结果优22例，良好7例，一般1例。所有患者在术后3个月吞咽困难症状完全消失。术后手术节段椎间隙丢失高度术后3个月时为（0．34±0．13）mm（0．1—0．6mm），术后1年（0．39±0．15）mm（0．2±0．7mm）。术后1年所有患者获植骨融合。结论：应用零切迹颈椎前路椎间融合固定系统手术治疗单节段颈椎间盘突出症，无须使用颈椎前路钢板，术中操作简便，术后临床效果良好，吞咽困难发生率低，生物力学稳定性良好，植骨融合率高，并发症少。Objective ：To explore the efficacy and safety of zero-profile implant for anterior cervical discectomy and fusion （ACDF） in treating single cervical disc herniation. Methods：From August 2011 to June 2012,30 patients with single cervical disc herniation were treated with ACDF using zero-profile implant in one motion segment. There were 18 males and 12 females with a mean age of 55.3 years old （ranged,36 to 68）. Incidence of dysphagia,height of intervertebral space and condition of bone fusion were observed after operation. Spinal nerves function and clinical results were assessed according to Japanese Or. thopaedic Association （JOA） score, Odom criteria. Results：All patients were followed up from 12 to 24 months with an aver- age of 15.9 months. The mean intraoperative blood loss was （85.3±14.2） ml （70 to 120 ml） and operative time was （90.0± 12.8） min （70 to 120 ml）. Preoperative,postoperative at 3 months and 1 year,JOA score was 8.72±2.36 （5.0 to13.0）, 14.72± 1.66 （11.5 to 17.0） and 15.65±1.03 （13.5 to 17.0） ,respectively. One year after operation ,according Odom criteria to assess, 22 cases got excellent results, 7 good, 1 fair. All dysphagiaes vanished completely at 3 months after operation. The lost height of intervertebral space was （0.34±0.13） mm （0.1 to 0.6 mm） and （0.39±0.15） mm （0.2 to 0.7 mm） at 3,12 months after opera- tion,respectively. All patients obtained bone fusion at 1 year after operation. Conclusion：The zero-profile implant is a valid alternative to anterior cervical plate in treating single cervical disc herniation with ACDF, it has advantages of convenient pro- cedure, satisfactory effect, lower incidence of postoperative dysphagia, reliable stability and less implant-related complications.

关 键 词：颈椎 椎间盘移位 椎间盘切除术 脊柱融合术 吞咽障碍 

分 类 号：R681.55[医药卫生—骨科学]