零切迹桥形锁定融合器与前路cage联合钛板固定治疗脊髓型颈椎病的疗效比较  

Comparison of the curative effect of zero-profile bridge-shaped locking cage and anterior cage combined with titanium plate fixation in the treatment of cervical spondylotic myelopathy

作　　者：赵哲[1] 寇红伟[1] 尚国伟[1] 姬彦辉 陈向荣 包德明 孙新志[1] 程田[1] 郭俊杰[1] 李劲峰[1] 刘宏建[1] 王义生[1] Zhao Zhe;Kou Hongwei;Shang Guowei;Ji Yanhui;Chen Xiangrong;Bao Deming;Sun Xinzhi;Cheng Tian;Guo Junjie;Li Jinfeng;Liu Hongjian;Wang Yisheng(Department of Orthopaedics,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院骨科,450052

出　　处：《中华骨科杂志》2021年第6期339-349,共11页Chinese Journal of Orthopaedics

基　　金：河南省高等学校重点科研项目计划(16A320017);河南省科技厅重点研发与推广专项项目(192102310118)。

摘　　要：目的探讨零切迹桥形锁定融合器(ROI-C)与前路cage联合钛板固定治疗双、三节段脊髓型颈椎病的疗效差异。方法回顾性分析2017年6月至2019年10月接受手术治疗的85例双、三节段脊髓型颈椎病患者的病历资料,男43例,女42例;年龄(52.3±8.0)岁(范围28~66岁);双节段63例、三节段22例。采用ROI-C治疗45例(ROI-C组),采用前路cage联合钛板固定40例(钛板组)。主要观察指标包括手术时间、术中出血量、颈椎Cobb角、融合节段Cobb角、平均椎间高度、疼痛视觉模拟评分(visual analogue scale,VAS)、日本骨科协会(Japanese Orthopaedic Association,JOA)评分和颈椎功能障碍指数(neck disability index,NDI)。结果85例患者随访时间为(16.9±2.0)个月(范围12~22个月)。双节段ROI-C组手术时间为(110.37±8.25)min,较钛板组(139.5±10.54)min短;术中出血量为(15.74±8.10)ml,较钛板组(23.71±9.70)ml少。三节段ROI-C组手术时间为(130.00±5.70)min,较钛板组(162.83±5.59)min短;而术中出血量的差异无统计学意义。术后1年ROI-C组双、三节段颈椎Cobb角分别为15.31°±1.55°、15.20°±0.42°,优于术前11.23°±2.03°、9.20°±1.14°;钛板组为15.89°±1.13°、16.08°±1.88°,优于术前11.25°±2.01°、9.00°±1.60°;术前及术后1年两组间的差异均无统计学意义。术后1年ROI-C组双、三节段VAS评分分别为(1.83±0.66)分、(2.60±0.52)分,低于术前(7.49±0.51)分、(7.60±0.52)分;钛板组为(1.79±0.50)分、(2.41±0.51)分,低于术前(7.61±0.63)分、(7.42±0.52)分;术前及术后1年两组间的差异均无统计学意义。术后1年ROI-C组双、三节段JOA评分分别为(15.00±0.84)分、(14.70±0.95)分,优于术前(7.20±0.87)分、(6.60±1.27)分;钛板组为(15.29±0.85)分、(14.83±0.58)分,优于术前(6.89±1.03)分、(6.92±0.67)分;术前及术后1年两组间的差异均无统计学意义;两组术后JOA改善率均为优。ROI-C组术后发生吞咽困难1例(2.22%,1/45),钛板组发生吞咽困�Objective To investigate the difference of curative effect between zero-profile bridge-shaped locking cage(ROI-C)and anterior cage combined with titanium plate fixation in the treatment of two-level and three-level cervical spondylotic myelopathy.Methods A total of 85 patients(43 males and 42 females),aged 52.3±8.0 years(range from 28 to 66 years)with bi-and three-level cervical spondylotic myelopathy who received surgical treatment from June 2017 to October 2019 were retrospectively analyzed.There were 63 cases of two levels and 22 cases of three levels.45 cases were treated with zero-profile bridge-shaped locking cage ROI-C(ROI-C group),and 40 cases with anterior cage combined with titanium plate fixation(titanium plate group).The main observation indicators include operation time,intraoperative blood loss,cervical Cobb angle,fusion segment Cobb angle,average intervertebral height,pain visual analogue scale(VAS),Japanese Orthopaedic Association(JOA)Score and neck disability index(NDI).Results All of 85 patients were followed up for 16.9±2.0 months(range 12 to 22 months).The operation time of two-level ROI-C group was 110.37±8.25 min,which was shorter than 139.5±10.54 min of titanium plate group;the intraoperative blood loss was 15.74±8.10 ml,which was less than 23.71±9.70 ml of titanium plate group;the operation time of three-level ROI-C group was 130.00±5.70 min,which was shorter than 162.83±5.59 min of titanium plate group,while the difference in the intraoperative blood loss between the two groups had no statistical significance.One year after operation,Cobb angle of cervical vertebra in double and three-level ROI-C groups were 15.31°±1.55°and 15.20°±0.42°,respectively,which were largerthan 11.23°±2.03°and 9.20°±1.14°before operation;in titanium plate group,they were 15.89°±1.13°and 16.08°±1.88°,which were higher than 11.25°±2.01°and 9.00°±1.60°before operation,and the differences had statistical significance.The differences between the two groups before operation and 1 year a

关 键 词：颈椎 脊髓压迫症 脊柱融合术 

分 类 号：R687.3[医药卫生—骨科学]