颈前路零切迹与钢板椎间融合系统治疗单节段脊髓型颈椎病疗效比较  

Zero-profile interbody fusion device versus plate cage benezech in the treatment of single-level cervical spondylotic myelopathy

作　　者：刘光普[1] 韩猛[1] 汤浩[1] 周婷婷[2] 张易[3] 王振飞[1] 刘磊[1] 刘光旺[4] 马超[1] Liu Guangpu Han Meng Tang Hao Zhou Tingting Zhang Yi Wang Zhenfei Liu Lei Liu Guangwang Ma Chao(Department of Orthopedic, Xuzhou Central Hospital, Affiliated Hospital of Medical College of Southeast University, Xuzhou 221009, China)

机构地区：[1]东南大学医学院附属徐州市中心医院骨科,江苏省徐州市221009 [2]江苏省徐州市第一人民医院 [3]徐州医学院附属医院 [4]徐州医学院徐州临床学院

出　　处：《中华解剖与临床杂志》2016年第6期541-546,共6页Chinese Journal of Anatomy and Clinics

基　　金：国家卫生计生委医药卫生科技发展研究中心项目（W2014ZT153）;江苏省科技厅临床医学科技专项（BL2014026）

摘　　要：目的：比较颈前路零切迹椎间融合系统（Zero-P）和颈前路钢板椎间融合系统（PCB）治疗单节段脊髓型颈椎病的疗效。方法采用前瞻性随机对照试验方法对2012年8月—2014年10月63例前路手术治疗的单节段脊髓型颈椎病患者进行研究。63例患者按随机数字表法分为 Zero-P 组（32例）和 PCB 组（31例）分别行 Zero-P 和 PCB 治疗。观察两组手术时间、术中失血、椎间高度、颈椎Cobb 角、JOA 评分、颈椎功能障碍指数（NDI）和远期并发症,远期并发症包括螺钉位置丢失、吞咽困难和骨性融合不佳。结果 Zero-P 组中1例因随访丢失予以剔除,最终每组均有31例研究对象。两组患者性别、年龄、手术节段、椎间高度、颈椎 Cobb 角、JOA 评分、NDI 评分差异均无统计学意义（P 值均＞0.05）。病例随访时间均大于12个月,Zero-P 系统组随访时间（15.52±1.93）个月；PCB 组随访（16.10±2.33）个月,差异无统计学意义（t =1.069,P ＞0.05）。 Zero-P 组、PCB 组手术时间分别为（63.45±10.87）、（85.97±12.04）min,术中出血量分别为（44.35±11.53）、（66.26±19.62）mL,差异均有统计学意义（t =7.730、5.358,P 值均＜0.01）。两组患者手术后及末次随访时的恢复椎间高度、颈椎 Cobb 角较术前明显改善,差异均有统计学意义（P 值均＜0.05）；两组间在手术后和末次随访时,恢复椎间高度、颈椎 Cobb 角水平差异均无统计意义（P 值均＞0.05）,但在末次随访时 PCB 组在术后维持 Cobb 角方面更有优势（P ＜0.05）。末次随访时两组 JOA 评分、NDI 评分均较术前明显改善（P值均＜0.05）,Zero-P 组的 NDI 评分改善程度优于 PCB 组（P ＜0.01）。至末次随访,两组病例均获骨性融合,其中 PCB 组出现2例螺钉位置丢失、3例吞咽困难,远期并发症方面 Zero-P 组优于 PCB 组（P ＜0.05）。结论 Zero-P 和 PCB 在治疗单节段脊髓型颈椎病均可获得较满Objective To compare the effectiveness between Zero-profile interbody fusion device （Zero-P） and plate cage benezech（PCB） in the treatment of single-level cervical spondylotic myelopathy. Methods From August 2012 to October 2014, 63 patients were divided into two groups of Zero-P（32 patients） and PCB（31 patients） by the prospective randomized method. Operative time, intraoperative blood loss, intervertebral height, cervical Cobb angle, Japanese Orthopedic Association （ JOA） score, neck disability index （NDI） and long-term complications, which contained loss of screw position, dysphagia and unfusion. Results One patient in Zero-P group was lost during the follow-up, so finally 31 patients were ineach group. General information of the two groups was comparable （ all P values 〉 0. 05）. All patients follow-up time was more than 12 months. Zero-P＇s follow-up time was （15. 52 ± 1. 93） months and PCB＇s was （16. 10 ± 2. 33） months （ P 〉 0. 05）. Operative time and blood loss [（63. 45 ± 10. 87） min;（44. 35 ± 11. 53 ） mL] of Zero-P group were significantly less than those [（ 85. 97 ± 12. 04 ） min, （66. 26 ± 19. 62） mL] of PCB group （ t = 7. 730, 5. 358, all P values 〈 0. 01）. Compared with the preoperative, the postoperative and last follow-up intervertebral height, cervical Cobb angle in the two groups could get good improvements （all P values 〈 0. 05）, and the postoperative and last follow-up＇s in the two groups had no significant difference （P 〉 0. 05）. What＇s more, the PCB group in maintaining postoperative cervical Cobb angle was better （ P 〈 0. 05）. At the last follow-up JOA score, NDI in two groups were significantly improved （all P values 〈 0. 05）, and the improvement of NDI in Zero-P group was better than PCB group （P 〈 0. 01）. At the last follow-up, all patients had bone fusion, but in PCB group there were two cases of screw position lost and three cases of dysphagia. Zero-P group was better in long-term c

关 键 词：颈椎 脊髓压迫症 脊柱融合术 零切迹颈前路椎间融合系统 颈前路钢板 椎间融合系统 

分 类 号：R687.3[医药卫生—骨科学]