联合单节段零切迹椎间融合器治疗三节段脊髓型颈椎病技术  

Clinical effect analysis of single-segment Zero-Profile intervertebral fusion cage in treatment of three-segment cervical spondylotic myelopathy

作　　者：陈毅[1] 刘晓东[2] 李晋虎 杨雪莹 王宏勤 范益民[2] 郑安潮[2] 刘跃亭[2] CHEN Yi;LIU Xiao-dong;LI Jin-hu(First Clinical Medical College,Shanxi Medical University,Taiyuan 030001,China)

机构地区：[1]山西医科大学第一临床医学院,太原030001 [2]山西医科大学第一医院神经外科

出　　处：《临床神经外科杂志》2020年第4期371-377,共7页Journal of Clinical Neurosurgery

基　　金：山西省重点研发计划项目(201903D321045)。

摘　　要：目的对比颈前路联合应用单节段零切迹椎间融合器与常规锁定钛板治疗三节段脊髓型颈椎病的临床疗效。方法回顾性分析18例采用颈前路椎间盘切除减压融合术(ACDF)+双节段锁定钛板固定系统+单节段零切迹椎间融合固定系统(联合组)和20例采用常规颈前路ACDF+三节段锁定钛板固定系统(常规组)患者的临床资料。分析两组患者术前、术后各指标及术后随访。结果联合组在手术时间、术中出血量、术后邻近节段退变率方面均明显优于常规组(均P<0.001)。两组患者术前及术后各随访时间点的VAS、JOA评分及颈椎Cobb角比较,差异均无统计学意义(均P>0.05)。末次随访时根据改良Macnab疗效评定标准,常规组优12例、良5例、可3例,优良率为85%;联合组优11例、良4例、可3例,优良率为83.3%。末次随访时两组间Ⅰ级融合率比较,差异无统计学意义(P>0.05)。结论颈前路联合零切迹椎间融合器治疗三节段脊髓型颈椎病可以取得与常规锁定钛板一样的疗效,但在缩短手术时间、减少术中出血量、降低邻近节段退变率以及降低手术难度方面具有优势。Objective To compare the clinical effect of anterior cervical approach combined with single-segment Zero-P intervertebral fusion cage and conventional locking titanium plate in the treatment of three-segment cervical spondylotic myelopathy.Methods The clinical data of 18 patients with ACDF+two-segment locking titanium plate fixation system+single-segment Zero-P intervertebral fusion fixation system(combined group)and 20 patients with conventional ACDF+three-segment locking titanium plate fixation system(conventional group),were analyzed retrospectively.Preoperative and postoperative indicators and postoperative follow-up were analyzed in the two groups.Results The combined group was superior to the conventional group in operation time,intraoperative blood loss,postoperative incidence of adjacent segment degeneration(all P<0.001).VAS,JOA score and Cobb Angle of cervical vertebra at each follow-up time point before and after operation were not significantly different between the two groups(all P>0.05).According to the modified Macnab standard at the last follow-up,12 cases were excellent,5 were good,and 3 were acceptable in the conventional group,with an excellent and good rate of 85%.In the combined group,11 cases were excellent,4 were good,and 3 were acceptable,with an excellent and good rate of 83.3%.At the time of the last follow-up,Ⅰlevel fusion rate between the two groups compare difference has no statistical significance(P>0.05).Conclusions In the treatment of three-segment cervical spondylotic myelopathy,anterior cervical approach combined with Zero-P intervertebral fusion cage can achieve the same clinical effect as conventional locking titanium plate,but it has advantages in shortening the operation time,decrease intraoperative blood loss,reducing the incidence of adjacent segment degeneration,and lower the difficulty of operation.

关 键 词：脊髓型颈椎病 手术治疗 植骨融合内固定 零切迹 

分 类 号：R651.2[医药卫生—外科学]