Baguera-C人工颈椎间盘置换与零切迹颈前路椎间融合治疗单节段颈椎病的疗效比较  

Comparison of the Therapeutic Effects of Artificial Cervical Disc Replacement with Baguera-C and Zero⁃profile Anterior Cervical Interbody Fusion in the Treatment of Single-level Cervical Spondylosis

作　　者：姜海军 赵衍斌 孙宇[1] 夏天[1] 杨枭雄 周非非[1] Jiang Haijun;Zhao Yanbin;Sun Yu;Xia Tian;Yang Xiaoxiong;Zhou Feifei(Department of Orthopedics,Peking University Third Hospital,Beijing 100191,China;Department of Orthopedics,Liangxiang Hospital,Fangshan District,Beijing 102401,China)

机构地区：[1]北京大学第三医院骨科,北京100191 [2]北京市房山区良乡医院骨科,北京102401

出　　处：《骨科》2024年第6期488-494,共7页ORTHOPAEDICS

摘　　要：目的比较Baguera-C人工颈椎间盘置换与零切迹(Zero-P)颈前路椎间融合治疗单节段颈椎病的疗效。方法回顾性分析在北京大学第三医院手术治疗的单节段颈椎病病人42例,21例采用Baguera-C人工颈椎间盘置换的病人纳入置换组,21例采用Zero-P行颈前路减压融合内固定术的病人纳入融合组。比较两组病人术前、术后3个月、末次随访时的日本骨科学会(JOA)评分、颈椎疼痛视觉模拟量表(VAS)评分、颈椎功能障碍指数(NDI)、颈椎曲度、C2~C7矢状面轴向距离(C-SVA)、T1倾斜角、手术节段的相邻节段活动度等。结果两组病人随访时间、手术时间和出血量比较,差异均无统计学意义(P>0.05)。置换组术后1例(4.76%)、融合组术后2例(9.52%)出现轻度吞咽困难,随访时症状逐渐缓解。在术前、术后3个月和末次随访这3个不同时间点,两组病人的JOA评分、VAS评分、NDI进行组内两两比较,差异均有统计学意义(P<0.05),但组间差异无统计学意义(P>0.05);末次随访时置换组的JOA评分改善率优于融合组(95.19%±9.08%vs.81.54%±27.35%),差异有统计学意义(P<0.05)。置换组术后3个月、末次随访的T1倾斜角均大于术前,差异有统计学意义(P<0.05);置换组4例(19.05%)出现异位骨化,均未影响置换节段的活动度。融合组术后3个月的颈椎曲度明显大于术前,末次随访时的上邻椎活动度明显大于术前及术后3个月,末次随访时的下邻椎活动度明显大于术前,差异均有统计学意义(P<0.05)。融合组病人末次随访时有2例未融合,融合率为90.48%。末次随访融合组下邻椎活动度大于置换组,差异有统计学意义(P<0.05)。结论Baguera-C人工颈椎间盘置换与Zero-P颈前路减压融合治疗单节段颈椎病均能取得较好的临床疗效,但Baguera-C人工颈椎间盘能够有效模拟椎间盘功能,保护小关节运动,有效减少相邻节段的退变发生。Objective To compare the therapeutic effects of cervical disc replacement with Baguera-C and zero-profile(Zero-P)anterior cervical interbody fusion in the treatment of single-level cervical spondylosis.Methods A retrospective analysis was conducted on 42 patients with single segment cervical spondylosis treated in Peking University Third Hospital.A total of 21 patients in the replacement group were treated by Baguera-C cervical disc replacement,21 cases in fusion group were treated with Zero-P anterior cervical interbody fusion.The Japanese Orthopaedic Association(JOA)score,vision analogue scale(VAS)score,neck disability index(NDI),cervical curvature,C2-C7 sagittal vertical axis(C-SVA),T1 tilt angle,range of motion of upper and lower adjacent segment were compared between the two groups before surgery,three months after surgery,and at the last follow-up.Results There were no statistically significant differences in follow-up time,operation time,and bleeding volume between the two groups(P>0.05).One case(4.76%)in the replacement group and two cases(9.52%)in the fusion group experienced mild swallowing difficulties after surgery,and the symptoms were gradually improved during the follow-up period.There were statistically significant differences in JOA scores,VAS scores and NDI between the two groups at different time points before surgery,three months after surgery,and the last follow-up(P<0.05),but there was no statistically significant difference between the groups(P>0.05).The improvement rate of JOA scores in the replacement group was better than that in the fusion group at the last follow-up(95.19%±9.08%vs.81.54%±27.35%),and the difference was statistically significant(P<0.05).The T1 tilt angle at 3rd month after surgery and last follow-up were significantly larger than that preoperation(P<0.05).Four cases(19.05%)in the replacement group showed ectopic ossification,which did not affect the mobility of the replacement segment.The cervical curvature of the fusion group at 3rd month after surgery was significant

关 键 词：颈椎病 椎间盘置换术 Baguera-C 零切迹 颈前路减压融合术 

分 类 号：R687.3[医药卫生—骨科学]