椎间融合器在外伤性颈椎间盘突出症前路融合术中的应用

Application of anterior intervertebral fusion with SOLIS for the treatment of traumatic cervical disc protrusion

目的探讨颈椎间融合器（SOLIS）治疗外伤性颈椎间盘突出症的临床疗效。方法53例单纯外伤性单节段颈椎间盘突出症患者，随机分成三组（A组、B组、C组），均按相同的标准完成颈椎前路减压术，A组18例植入带自体松质骨的SOLIS，B组16例植入带自体松质骨的Syneage，C组19例植骨加ACPS行颈椎融合。观察三组骨融合情况、稳定性和椎间隙高度变化，并以JOA评分评价神经功能恢复情况。结果全部患者均于术后3～9个月骨性融合；术后随访平均16．5个月，A组SOLIS位置良好，病变椎间隙高度和颈椎生理曲度恢复正常并无丢失发生，术前后JOA评分分别为：（10．4±2．4）、（14．9±2．0）分（P〈0．01）；B组5例Syncage塌陷，椎间高度和颈椎生理曲度丢失，术前后JOA评分分别为：（10．6±2．5）、（13．2±2．3）分（P〈0．05）；C组18例ACPS位置良好，1例发生螺钉钛板滑脱，术前后JOA评分分别为：（10．5±2．4）、（15．1±1．9）分（P〈0．01）；手术后JOA评分A组和C组之间比较差异无统计学意义（P〉0．05），A、C组同B组之间比较均有统计学意义（均P〈0．05）。结论SOLIS用于单纯外伤性单节段颈椎间盘突出症的治疗融合率高，神经功能改善优良率高，椎间高度丢失低。

Objective To evaluate the application of SOLIS in the surgery on anterior intervertebral fusion for the treatment of traumatic cervical disc protrusion. Methods 53 traumatic single segment cervical disc protrusion were divided into three groups randomly. The A group （SOLIS） ：n = 18, SOLIS filled with autocancellous bone were implanted between the cervical vertebrae. The B group（Syncage） ：n = 16 ,as the first group Syncage filled with auto- cancellous bone were implanted. The C group ： n = 19, anterior cervical decompression and fusion with bone autograft and internal fixation with ACPS. The operations of the surgery on anterior cervical decompression in three groups were the same. Recovery of nerve function was observed by JOA score and the fusion state, stability and changes of intervertebra height of fusion segment were evaluated by X ray. Results The average duration of the follow-up was 16. 5 months in 53 cases. Bony fusion could be found 3 - 9months after operation in all cases. In all A（SOLIS） group cases, the movement of the implanted SOLIS Cage were not found. The heights of the cervical intervertebral spaces and the physiological eurvature were restored without loss in the duration of follow-up. The average JOA was（ 10. 4 ±2.4）before operation and（ 14. 9 ± 2. 0）after operation. There was highly significant variation between the former and the latter （P 〈 0. 01 ）. In the B （Syneage）group ,5 cases had eage subsidence, therefore the height of intervertebra and the physiologlcal curvature were lost. The average JOA was（ 10. 6 ±2. 5） before operation and（ 13.2± 2. 3） after operation. There was significant variation between the former and the latter（ P 〈 0. 05 ）. In the C group the third group, the movement of the fixed titanium plate were not found in the duration of follow-up in 18 eases. The titanium plate fixation was loose in 1 case. The average JOA was （ 10. 5 ±2.4） before operation and （ 15. 1± 1.9） after operation. There was highly significant variation between the former and the latter（ P 〈 0. 01 ）. After operation ,there was significant difference in the JOA score between the A group and the B group, between the C group and the B group （ P 〈 0. 05 ） , and there was no difference between the A group and the C group（ P 〉 0. 05 ）. Conclusion Treatment of single segment prolapse of the cervical intervertebral disc with SOLIS cage has some advantages such as higher fusion rate, higher recovery rate of nerve function and low rate of loss of intervertebral height.