颈前路椎间盘切除融合术联合零切迹自锁式椎间融合器治疗颈椎病的临床疗效分析  

Clinical effects of anterior cervical discectomy and fusion combined with zero-profile anchored spacer application on cervical spondylosis

作　　者：连学辉 韩子冀[1] 肖红利 雷高 秦相营 Lian Xuehui;Han Ziji;Xiao Hongli;Lei Gao;Qin Xiangying(Department of Orthopedics,First People's Hospital of Guiyang,Guiyang 550000,Guizhou Province,China;Department of Spine,Yunnan Sino-German Orthopedic Hospital,Kunming 650000,Yunnan Province,China)

机构地区：[1]贵阳市第一人民医院骨科,550000 [2]云南中德骨科医院脊柱科,昆明650000

出　　处：《中国基层医药》2021年第9期1347-1352,共6页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的观察颈前路椎间盘切除融合术(ACDF)联合零切迹自锁式椎间融合器(ROI-C)治疗颈椎病的临床疗效。方法回顾性分析贵阳市第一人民医院2015年5月至2018年5月应用ACDF联合ROI-C治疗颈椎病的患者89例,其中男58例,女31例,共融合138个节段。记录手术时间、术中出血量、术后并发症及其发生率。采用日本骨科协会评分(JOA)、疼痛视觉模拟评分(VAS)和颈部残疾指数评分(NDI)评价临床治疗效果。通过影像学检查,观察患者颈椎曲度、融合节段椎间隙高度、椎体间融合率以及邻近节段的变化情况,评估患者术后颈椎的稳定性及远期效果。结果89例手术患者随访时间为(25.6±6.8)个月,最小12个月,最长36个月。单节段53例,手术时间为(85.54±12.53)min,出血量为(58.45±10.24)mL;双节段25例,手术时间为(115.57±16.42)min,出血量为(92.62±12.44)mL;三节段9例,手术时间为(148.63±19.42)min,出血量为(118.54±11.25)mL;四节段2例,手术时间及出血量分别为188 min、175 mL及214 min、225 mL;术后1周至12个月随访时患者的JOA评分显著增加,NDI评分显著降低,VAS评分亦显著降低,差异均有统计学意义(F=11.25、26.35、20.26,均P<0.05)。术后仅2例出现吞咽不适感,发生率为2.2%;患者均未出现切口血肿、感染、声音嘶哑、呛咳等并发症。术后1周至12月随访时患者的颈椎曲度、融合节段椎间隙高度均优于术前,差异均有统计学意义(均P<0.05);术后12个月X线检查均获得骨性融合,无融合器松动移位,未见邻近节段有明显退变。结论采用ACDF联合ROI-C治疗颈椎病疗效良好,术后明显缓解患者症状及改善颈椎功能。Objective To investigate the clinical effects of anterior cervical discectomy and fusion combined with zero-profile anchored spacer(ROI-C)application on cervical spondylosis.Methods Eighty-nine patients,consisting of 58 males and 31 females,who received anterior cervical discectomy and fusion combined with zero-profile anchored spacer(ROI-C)application in First People's Hospital of Guiyang from May 2015 to May 2018 were retrospectively analyzed.A total of 138 segments were fused.Operative time,intraoperative blood loss,postoperative complications and their incidence were recorded.The Japanese Orthopaedic Association score,Visual Analogue Scale score,and Neck Disability Index score were used to evaluate clinical effects of anterior cervical discectomy and fusion combined with ROI-C application.Imaging examination was performed to determine cervical curvature,intervertebral space height of fused segments,interbody fusion rate and changes in adjacent segments.The stability and long-term effects of postoperative cervical spine were evaluated.Results All 89 patients were followed up for(25.6±6.8)months(range 12-36 months).In 53 patients who underwent single-segment fusion,operative time was(85.54±12.53)minutes and the amount of blood loss was(58.45±10.24)mL.In 25 patients who underwent two-segment fusion,operative time was(115.57±16.42)minutes and the amount of blood loss was(92.62±12.44)mL.In 9 patients who underwent three-segment fusion,operative time was(148.63±19.42)minutes and the amount of blood loss was(118.54±11.25)mL.In 2 patients who underwent four-segment fusion,operative time and the amount of blood loss were 188 minutes and 175 mL,respectively in one patient and they were 214 minutes and 225 mL in another patient,respectively.With time went during 1 week to 12 months after surgery,Japanese Orthopaedic Association score was greatly increased,Neck Disability Index score was remarkably decreased,and Visual Analogue Scale score was also significantly decreased(F=11.25,26.35,20.26,all P<0.05).Swallowing

关 键 词：颈椎 椎间盘切除术 脊柱融合术 手术时间 失血 手术 疼痛测定 

分 类 号：R687.3[医药卫生—骨科学]