零切迹椎间融合器与独立和钛板椎间融合器联合对双节段跳跃型颈椎病的疗效比较  

Efficacy comparison of zero-profile intervertebral fusion and stand-alone interbody cage combined with cage-titanium plate construct in treatment of two-segment skip cervical spondylosis

作　　者：夏毕成 孙建广[1] 黄世磊[1] 田凌阳 朱艺豪 皮国富[1] Xia Bicheng;Sun Jianguang;Huang Shilei;Tian Lingyang;Zhu Yihao;Pi Guofu(Department of Orthopedics,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,郑州450052

出　　处：《中华医学杂志》2022年第19期1450-1457,共8页National Medical Journal of China

摘　　要：目的比较双节段跳跃型颈椎病患者行前路减压融合术(ACDF)中应用零切迹椎间融合器(ROI-C)和独立椎间融合器联合钛板椎间融合器的临床疗效的差异。方法回顾性分析2017年6月至2020年6月在郑州大学第一附属医院接受手术治疗的62例双节段跳跃型颈椎病患者的临床资料, 其中男38例, 女24例, 年龄(53.3±8.5)岁。33例采用ROI-C治疗, 29例采用独立椎间融合器联合钛板椎间融合器(融合器+钛板组)。观察比较两组手术时间、术中出血量、吞咽困难Bazaz分级、日本骨科(JOA)评分、疼痛视觉模拟评分(VAS)、颈椎功能障碍指数(NDI)、融合节段平均椎间隙高度、C2~7 Cobb角变化及并发症情况。结果术后随访(28±5)个月(16~34个月), ROI-C组手术时间(127.6±34.2)min, 较融合器+钛板组的(157.1±43.9)min短, 差异有统计学意义(P=0.004)。术后3个月, 两组JOA、VAS评分均较术前明显改善, 且两组间差异均无统计学意义(均P>0.05)。ROI-C组融合节段平均椎间隙高度术前为(6.02±1.03)mm, 术后3个月提高至(8.38±1.47)mm, 术后12个月为(8.16±1.40)mm, 融合器+钛板组则分别为(6.24±1.05)、(8.58±1.18)和(7.87±0.73)mm, 两组间同期差异均无统计学意义(均P>0.05)。术前ROI-C组颈椎Cobb角为10.5°±6.8°, 术后3个月改善为19.2°±9.0°, 术后12个月为18.2°±5.8°, 融合器+钛板组则分别为10.9°±4.6°、18.5°±7.8°和17.1°±5.2°, 两组间同期差异均无统计学意义(均P>0.05)。ROI-C组术后吞咽困难发生率为9.1%(3/33), 融合器+钛板组37.9%(11/29), 差异有统计学意义(P=0.007)。结论对于双节段跳跃型颈椎病应用ROI-C和融合器+钛板均能取得良好效果。ROI-C在缩短手术时间、减少术后早期吞咽困难上更有优势。Objective To investigate the difference in clinical efficacy between zero-profile interbody fusion(ROI-C)and stand-alone interbody cage combined with cage-titanium plate construct for patient with two-segment skipped cervical spondylosis who received the anterior cervical discectomy and fusion(ACDF)surgical strategies.Methods The clinical data of 62 patients with two-segment skipped cervical spondylosis who underwent surgical treatment in the First Affiliated Hospital of Zhengzhou University from June 2017 to June 2020 were retrospectively analyzed,included 38 males and 24 females,aged(53.3±8.5)years.Thirty-three cases were treated with ROI-C(ROI-C group),and 29 cases with stand-alone interbody cage combined with cage-titanium plate construct(cage+titanium plate group).The following parameters,including operation time,intraoperative blood loss,dysphagia Bazaz grade,Japanese Orthopaedic Association(JOA)score,visual analogue scale(VAS)of pain,neck disability index(NDI),average intervertebral height of operated segments,C2-7 Cobb angle,and related complications,were compared between the two groups.Results The patients were followed up for(28±5)months(16-34 months).The operation time of ROI-C group was(127.6±34.2)min,which was shorter than that in cage+titanium plate group[(157.1±43.9)min,P=0.004].The scores of JOA and VAS in both ROI-C group and cage+titanium plate group were significantly improved 3 months after operation when compared with those before operation,and there was no significant difference between the two groups(all P>0.05).The average intervertebral space height of fusion segment in ROI-C group was(6.02±1.03)mm before operation,it was improved to(8.38±1.47)mm at 3 months after operation,(8.16±1.40)mm at 12 months after operation,and it was(6.24±1.05)mm,(8.58±1.18)mm and(7.87±0.73)mm in cage+titanium plate group,respectively,and there was no significant difference between the two groups at each time point(all P>0.05).The Cobb angle of cervical vertebrae in ROI-C group was 10.5°±6.8°before

关 键 词：颈椎 双节段跳跃型颈椎病 颈椎前路间盘切除融合术 零切迹椎间融合器 独立联合钛板椎间融合器 

分 类 号：R687.3[医药卫生—骨科学]