零切迹融合器与钛板椎间融合器内固定治疗伴后凸畸形的脊髓型颈椎病  

Comparison clinical and radiographic outcomes between plate/cage constructs and zero-profile devices in the treatment of cervical spondylotic myelopathy patients with cervical kyphosis

作　　者：王超 石志才 栗景峰 毛宁方 李强华 袁佳滨 林徐苗 黄泽彬 Wang Chao;Shi Zhicai;Li Jingfeng;Mao Ningfang;Li Qianghua;Yuan Jiabin;Lin Xumiao;Huang Zebin(Department of Spine Surgery,Changhai Hospital Affiliated to Naval Medical University,Shanghai 200433,China;Health Company of PLA 73653 Troops,Quanzhou 362341,China)

机构地区：[1]海军军医大学附属长海医院脊柱外科,上海200433 [2]中国人民解放军73653部队卫生连,泉州362341

出　　处：《中华骨科杂志》2020年第22期1513-1521,共9页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金(81672204)。

摘　　要：目的:探讨零切迹椎间融合器与钛板椎间融合器内固定治疗伴有后凸畸形的脊髓型颈椎病的疗效。方法:回顾性分析2016年8月至2018年7月接受颈椎前路减压植骨融合内固定治疗的伴有后凸畸形的脊髓型颈椎病患者54例,26例采用零切迹椎间融合器(零切迹组)、28例采用钛板椎间融合器(钛板组)。两组患者性别、年龄、体质指数、手术节段的差异无统计学意义。比较两组患者手术时间、术中出血量,采用颈部疼痛视觉模拟评分(visual analogue scale,VAS)、日本骨科协会(Japanese Orthopedic Association,JOA)评分及恢复率评价临床疗效;于颈椎侧位及动力位X线片测量颈椎前凸角、手术节段Cobb角、C 2~7矢状面垂直轴(C 2 sagittal vertical axis,C 2 SVA)和颈椎活动度(range of motion,ROM),评估颈椎矢状面平衡的变化。 结果:零切迹组手术时间(83.0±14.9) min范围(60~120 min)、术中出血量(70.5±27.3) ml(范围30~150 ml),钛板组手术时间(100.0±23.9) min(范围65~145 min)、术中出血量(104.2±38.8) ml(范围30~250 ml),两组差异有统计学意义( t=3.40,2.06;P=0.00,0.04)。零切迹组随访(30.4±5.8)个月(范围24~36个月),钛板组随访(31.2±4.9)个月(范围24~36个月)。零切迹组VAS和JOA评分分别由术前(5.9±1.0)分和(9.2±1.7)分改善至术后1个月的(2.1±0.8)分和(14.9±1.0)分、末次随访时的(3.4±1.0)分和(15.1±0.9)分,手术前后的差异有统计学意义( F=130.96,221.40;P=0.00);钛板组VAS和JOA评分分别由术前(5.9±1.1)分和(8.7±1.6)分降至术后1个月的(2.3±0.9)分和(14.9±1.0)分、末次随访时的(2.6±0.9)分和(15.6±1.1)分,手术前后的差异有统计学意义( F=303.35,126.64;P=0.00);零切迹组末次随访时颈痛VAS评分较术后1个月明显升高,且大于钛板组( P<0.05)。零切迹组颈椎前凸角和手术节段Cobb角由术前-6.7°±2.7°和-6.5°±3.2°改善为术后1个月的14.2°±4.9°和12.9°±4.9°、末次随访时的5.9°±4.7°和5.0°±4Objective To compare the clinical outcomes and correction effects of kyphosis between Zero-profile device(Zero-p)and plate/cage structures(PCC)in treating cervical spondylotic myelopathy(CSM)patients with cervical kyphosis.Methods From August 2016 to July 2018,a total of 54 cases of cervical spondylotic myelopathy patients with cervical kyphosis were analyzed retrospectively,including 26 cases treated with Zero-p and 28 cases treated with PCC system.There was no significant difference between the two groups in gender,age,body mass index(BMI)and operative segment.The operation duration and the blood loss were recorded.The clinical outcomes of the patients were measured by visual analogue score(VAS)for neck pain and Japanese Orthopedic Association(JOA)score for neurological function.Moreover,JOA recovery rate was obtained to assess the surgical results.The cervical lordosis(C2-C7 Cobb angle),the Cobb angle of the operation segment,the C2-C7 vertical axis(C2 SVA)and the cervical range of motion(ROM)were measured on the lateral and dynamic radiographs of the cervical spine,respectively.Results In the Zero-p group,the operation duration was 83.0±14.9(range 60-120)min,intraoperative blood loss was 70.5±27.3(range 30-150)ml.In PCC group,the operation duration was 100.0±23.9(range 65-145)min,intraoperative blood loss was 104.2±38.8(range 30-250)ml.There were significant difference in above parameters between two groups(t=3.40,2.06;P=0.00,0.04).The follow-up duration in Zero-p group was 30.4±5.8(range 24-36)months and 31.2±4.9(range 24-36)months in PCC group without significant difference(t=1.061,P=0.291).The VAS/JOA score of the Zero-p group was improved from(5.9±1.0)/(9.2±1.7)preoperatively to(2.1±0.8)/(14.9±1.0)at 1 month postoperatively,and to(3.4±1.0)/(15.1±0.9)at the last follow-up.The difference between them was statistically significant(F=130.96,221.40,P=0.00).The VAS/JOA score of the PCC group was improved from(5.9±1.1)/(8.7±1.6)preoperatively to(2.3±0.9)/(14.9±1.0)at 1 month after surgery,and to(

关 键 词：颈椎病 脊柱后凸 脊柱融合术 治疗结果 

分 类 号：R687.3[医药卫生—骨科学]