颈椎动态稳定器植入与颈前路减压融合内固定治疗脊髓型颈椎病的比较  

A comparative study on the treatment of cervical spondylosis with the surgery of dynamic cervical implant implantation and anterior decompression fusion with cage

作　　者：贾杰[1] 刘宏建[1] 尚国伟[1] 吴志彬[1] 王俊魁[1] 周权发[1] 皮国富[1] 

机构地区：[1]郑州大学第一附属医院骨科,450052

出　　处：《中华实验外科杂志》2015年第11期2878-2880,共3页Chinese Journal of Experimental Surgery

摘　　要：目的 比较颈椎动态稳定器（DCI）植入术与颈前路减压融合内固定术（ACDF）治疗单节段脊髓型颈椎病的中期疗效.方法 对行DCI植入术（DCI组）的23例患者,与行颈前路减压融合内固定术（ACDF组）的47例患者进行随访,分别于术后24、36、48个月末行日本矫形外科协会（JOA）评分,并拍摄X线片观察手术节段椎间隙的高度和活动度以及上下邻近节段的活动度.结果 两组术后各期的JOA评分和椎间隙高度与术前比较差异均有统计学意义（P＜0.05）,随访各期组间比较差异无统计学意义（P＞0.05）.DCI组手术节段的活动度在各随访期末与术前比较差异无统计学意义（P＞0.05）;其上下邻近节段的活动度在随访期末[（6.99±0.56）°、（6.83±0.35）°]与术前[（6.78±0.51）°、（6.63 ±0.48）°]比较差异无统计学意义（P＞0.05）,而ACDF组随访期末上下邻近节段活动度[（8.56 ±0.51）°、（8.34±0.43）°]均较术前[（6.81±0.53）°、（6.67±0.49）°]增加（P＜0.05）.结论 两种手术均能明显缓解患者症状,恢复并维持椎间隙高度.与ACDF比较,DCI为手术节段提供持续的动态稳定,可减缓邻近节段的退变,但手术节段的椎体可能出现退变增生.Objective To compare post-operative mid-term clinical outcomes between dynamic cervical implant （DCI） non-fusion group and anterior cervical discectomy and fusion （ACDF） group.Methods From March 2011 to January 2013, 23 patients were subjected to DCI non-fusion and 47 to ACDF respectively.The clinical outcomes were evaluated by the Japanese Orthopaedic Association （JOA） scores and all treated patients re-examined by lateral （full extention） views during follow-up at 24th month, 36 month, and 48 month respectively aiming to observe the intervertebral height of the treated level and the segmental range of motion （ROM） of adjacent levels of treated 1 evel in both two groups.Results Both the two groups showed good clinical outcomes by JOA scores.We found no statistically significant difference between them （P 〉 0.05）.There was also no statistically significant difference between them in recovering and keeping the intervertebral height of the treated level and the ROM of it at the end of the follow-up.At final following-up the ROM of target adjacent levels treated with DCI [（6.99 ± 0.56）°, and （6.83 ± 0.35） °] was not significantly different from that pre-operation [（6.78 ± 0.51） °, and （6.63 ± 0.48） °, P 〉 0.05].In ACDF group, the ROM of adjacent levels treated postoperation [（8.56 ± 0.51） °, and （8.34 ± 0.43） °] at final following-up was significantly increased as compared with pre-operation [（6.81 ±0.53）°, and （6.67 ±0.49）°] （P〈0.05）.Conclusion Both the two groups can effectively treat the cervical diseasedand greatly recover the intervertebral height of the treated level.But DCI non-fusion can prevent the compensatory hyper-motion at adjacent 1 evels compared with ACDF.As a result, DCI non-fusion greatly decreases the rate of developing degenerative lesions, but the vertebral body of the surgery segment degeneration may occur.

关 键 词：颈椎动态稳定器 退变 中期随访 

分 类 号：R681.55[医药卫生—骨科学]