颈椎前路椎间盘切除融合术中可变角度零切迹椎间融合器与钛板椎间融合器固定的疗效比较  

Comparative study on the efficacy of Zero-PVA versus titanium plate in single-level ACDF treatment and analysis of radiographic influencing factors

作　　者：黄靖 熊云宇 周子然 何恒涛 王兵[1] Huang Jing;Xiong Yunyu;Zhou Ziran;He Hengtao;Wang Bing(Department of Orthopaedics,the First Affiliated Hospital of Kunming Medical University,Kunming 650032,China;Department of Plastic and Cosmetic Surgery,the Affiliated Calmette Hospital of Kunming Medical University,Kunming 650100,China)

机构地区：[1]昆明医科大学第一附属医院骨科,昆明650034 [2]昆明医科大学附属甘美医院整形美容科,昆明650100

出　　处：《中华骨科杂志》2025年第4期205-214,共10页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金(82260449)。

摘　　要：目的探讨颈椎前路椎间盘切除融合术(anterior cervical discectomy and fusion,ACDF)中应用可变角度零切迹椎间融合器(zero-profile interbody fusion device with variable angle,Zero-PVA)或钛板椎间融合器(cage-plate constructs,CP)治疗单节段颈椎病的疗效,并分析临床疗效与影像学参数的相关性。方法回顾性分析2019年1月至2022年6月在昆明医科大学第一附属医院接受单节段ACDF治疗的70例颈椎病患者的资料,男32例、女38例,年龄(51.34±8.62)岁(范围29~77岁)。根据使用的椎间融合器类型分为CP组和Zero-PVA组(ZP组)。CP组35例,年龄(51.51±10.02)岁(范围29~77岁);ZP组35例,年龄(51.17±7.11)岁(范围38~68岁)。临床指标包括疼痛视觉模拟评分(visual analogue scale,VAS)、颈椎功能障碍指数(neck disability index,NDI)、日本骨科协会(Japanese Orthopaedic Association,JOA)评分,影像学指标包括手术节段椎间隙高度、颈椎前凸角、手术节段Cobb角、T_(1)倾斜角(T_(1) slope,T 1S)及颈椎矢状位平衡(C_(2)~C_(7) sagittal vertical axis,C_(2)~C_(7) SVA),记录术后1周及末次随访时Bazaz吞咽困难评级和末次随访时Odom手术疗效评级、患者的融合等级、邻近椎体异位骨化等级及邻近节段退变情况。按照Odom评级将患者分为症状缓解组与症状缓解不全组,应用二分类logistic回归分析影像学参数与ACDF术后症状缓解不全的相关性,采用受试者特征曲线(receiver operating characteristic curve,ROC)确定可能影响术后疗效的相关影像学参数临界值。结果两组患者性别、年龄、手术节段、颈椎病分型和随访时间的差异均无统计学意义(P>0.05)。术后1周及末次随访时两组患者VAS、NDI、JOA评分的差异均无统计学意义(P>0.05)。CP组术后1周、末次随访时的吞咽困难发生率分别为49%和20%,高于ZP组的14%和0(P<0.05)。CP组术后1周、末次随访的椎间隙高度为(9.16±0.84)mm和(8.19±1.11)mm,高于ZP组的(8.22±1.23)mm和(7.5Objective To investigate the clinical and radiological differences in treating single-level cervical spondylosis using the Zero-profile interbody fusion cage(Zero-PVA)versus the titanium plate interbody fusion cage in anterior cervical discectomy and fusion(ACDF)and to analyze the correlation between clinical outcomes and radiological parameters.Methodsthis retrospective study collected data from patients with cervical spondylosis who underwent single-level ACDF surgery at the First Affiliated Hospital of Kunming Medical University between January 2019 and June 2022.A total of 70 patients(32 males and 38 females)with an average age of 51.34±8.62 years(range:29 to 77 years)were included.Based on the type of interbody fusion device used,patients were divided into two groups:the cage-plate construct(CP)group(35 patients;average age:51.51±10.02 years,range:29 to 77 years)and the zero-profile interbody fusion device with variable angle(ZP)group(35 patients;average age:51.17±7.11 years,range:38 to 68 years).Preoperative,one-week postoperative,and final follow-up(≥6 months postoperative)data were collected for visual analogue scale(VAS)scores,neck disability index(NDI)scores,and Japanese Orthopaedic Association(JOA)scores.Radiological parameters assessed included surgical segment intervertebral disc height,cervical lordosis angle,surgical segment Cobb angle,T_(1) slope(T_(1S)),and C_(2)-C_(7) sagittal vertical axis(C_(2)-C_(7) SVA).Additional evaluations included Bazaz dysphagia ratings at one week and final follow-up,Odom surgical outcome ratings at final follow-up,fusion grades,adjacent vertebral ectopic ossification grades,and adjacent segment degeneration.Patients were further classified into a symptom relief group and an incomplete symptom relief group based on Odom ratings.Logistic regression analysis was performed to examine the correlation between radiological parameters and postoperative outcomes.Statistical methods such as ROC curves,Youden index,product index,and Euclidean index were used to determine op

关 键 词：颈椎病 脊柱融合术 治疗结果 危险因素 

分 类 号：R687.3[医药卫生—骨科学]