ROI-C前路手术治疗无椎节不稳、骨折或脱位TCDH临床疗效观察  

Clinical Observation of ROI-C Anterior Surgical Treatment of TCDH without Vertebral Instability,Fracture or Dislocation

作　　者：彭辉[1] 庄小强[1] 陆生林[1] 白宇[1] 方旭[1] 黄晖[1] PENG Hui;ZHUANG Xiao-qiang;LU Sheng-lin;BAI Yu;FANG Xu;HUANG Hui(Affiliated Minzu Hospital of Guangxi Medical University,Nanning 530021 ,Gnangxi, China)

机构地区：[1]广西医科大学附属民族医院,南宁530001

出　　处：《中国现代手术学杂志》2017年第4期274-278,共5页Chinese Journal of Modern Operative Surgery

摘　　要：目的探讨无椎节不稳、骨折或脱位的创伤性颈椎间盘突出(traumatic cervical disc herniation,TCDH)患者单独采取双插片自稳式融合系统(double-plate self-locking interbody fusion device,商品名ROI-C)前路手术治疗的初期效果并对该手术方法进行评价。方法回顾性分析2008年1月至2016年1月于我院治疗的TCDH患者120例,观察比较应用ROI-C前路手术治疗前后日本骨科协会评分(Japanese Orthopaedic Association scores,JOA)、视觉疼痛模拟评分(visual analogue scale,VAS)、颈椎功能障碍指数(neck disability index,NDI)、颈椎整体曲度的改变及椎间高度,依据Vaccraro标准对植骨融合情况进行评估,应用Odom法对手术治疗效果进行评定。结果 120例患者均获得随访,随访时间13~34个月,平均19.5个月。手术前至末次随访评分的比较,治疗后JOA评分由4.4±3.9增加为13.9±2.7;VAS评分由6.4±2.1下降为1.1±0.8;NDI评分由38.3%±11.8%减少为8.8%±3.3%,末次随访前与术前的差异均具有统计学意义(P<0.05)。治疗后椎间高度由(5.3±1.6)mm增加为(7.9±0.7)mm,颈椎曲度由5.2°±7.4°增加为10.6°±5.2°,差异具有统计学意义(P<0.05)。术后2周声音嘶哑患者症状消失,术后3个月吞咽困难患者症状消失,术后6个月120例节段均发生骨性融合,随访期间无ROI-C下沉、移位及断裂现象的发生。依据Odom标准评优率为76.5%。结论单独采取ROI-C前路手术方式治疗无椎节不稳、骨折或脱位的TCDH患者,确实具有治疗效果较好、融合率高及并发症少等优势,ROI-C前路固定融合治疗是一种可靠的微创手术方法,值得临床推广。Objective To investigate the effect of double-plate self-locking interbody fusion device（ROI-C） on the treatment of traumatic cervical disc herniation（TCDH） without vertebral instability,fracture or dislocation,and to evaluate the effect of surgery. Methods A total of 120 patients with TCDH who were treated in our hospital from January 2008 to January 2016 were retrospectively analyzed. The pre-and post-operative Japanese Orthopedic Association score（JOA） and visual analogue score（VAS） were observed and compared. The neck disability index（NDI）,total cervical curvature changes and intervertebral heights,Vaccraro criteria for bone graft fusion assessment,and Odom criteria were used to evaluate the surgical effects.Results All patients were followed up for 13 to 34 months with an average of 19.5 months. The JOA score increased from4.4±3.9 to 13.9±2.7 by the end of the follow-up. The VAS decreased from 6.4±2.1 to 1.1±0.8（P0.05）; The NDI decreased from 38.3% ±11.8% to 8.8% ±3.3%（P0.05）. The intervertebral height increased from（5.3±1.6） mm to（7.9±0.7） mm（P0.05）; The curvature of the cervical spine increased from 5.2° ±7.4 ° to 10.6° ±5.2 °（P0.05）. The sym ptom s of hoarseness disappeared 2 months later. The symptoms of dysphagia disappeared 3 months later. All the segments got bony fusion 6 months later.There was no ROI-C sinking,displacement or fracture phenomenon occurred. According to the Odom criteria,the excellent rate was 76. 7%（92/120）. Conclusions The treatment of TCDH without vertebral instability,fracture or dislocation by the ROI-C anterior approach alone does have the advantages of good therapeutic effect,high fusion rate and less complication. ROI-C anterior fusion therapy is a reliable minimally invasive surgical method,which is worthy of clinical promotion.

关 键 词：双插片自稳式融合系统 颈椎损伤 椎间盘移位 椎间盘切除术 内固定器 

分 类 号：R687.3[医药卫生—骨科学]