锚定式颈椎椎间融合器临床应用初步报告

PRELIMINARY CLINICAL STUDY OF ANCHORING CERVICAL INTERVERTEBRAL FUSION CAGE

目的探讨锚定式颈椎椎间融合器(anchoring cervical intervertebral fusion cage,ACIFC)在颈椎前路椎间盘切除减压、植骨融合手术中的临床应用价值。方法2006年11月-2007年6月,收治颈椎退行性疾患21例,均经前路行椎间盘切除减压、组件型ACIFC植骨、固定片锚定术,共植入ACIFC28枚。其中男12例,女9例;年龄25～68岁,平均47.9岁。病程3d～15年,中位时间2.3年。单节段颈椎病7例,双节段颈椎病3例,单节段下颈椎不稳2例,单节段颈椎病合并下颈椎不稳4例,颈椎间盘突出症5例。术后定期摄X线片,判定植骨融合情况并测量融合节段的椎间高度变化,采用40分评分系统评价患者术前、术后即刻、术后随访的症状、体征及功能,根据曾岩等标准评价术后颈部轴性症状(axial symptom,AS)的发生情况。结果术后切口均Ⅰ期愈合。术后48h内发生AS1例,经对症治疗后按曾岩等标准评价已由差恢复为良。术中、术后未出现其他并发症。患者均获随访,随访时间16～24个月,平均20.5个月,28个椎间盘均获融合。颈脊髓功能评分术前平均26.2分,术后即刻平均30.6分,末次随访时平均35.5分;各时间点间比较差异均有统计学意义(P<0.05)。随访1年以上颈脊髓功能改善率平均67.4%。椎间高度:术前平均1.9mm,术后即刻平均4.4mm,末次随访时平均4.3mm,术后即刻及末次随访时与术前比较差异均有统计学意义(P<0.05)。随访期内未见邻近节段发生退行性变。结论采用ACIFC行植骨融合及内固定治疗退行性颈椎疾患简便快捷、适应证广,临床疗效满意,在恢复和维持椎间高度方面疗效确切。

Objective To study the cl inical appl ication of anchoring cervical intervertebral fusion cage （ACIFC） in anterior cervical discectomy with fusion. Methods From November 2006 to June 2007, 21 cases of degenerative cervical disease were treated with anterior cervical discectomy, bone graft by ACIFC and anchoring stators, and 28 ACIFCs were implanted. There were 12 males and 9 females aged 25-68 years old （average 47.9 years old）. The course of disease ranged from 3 days to15 years （median 2.3 years）. There were 7 patients with single-segment cervical spondylosis, 3 with two-segment cervical spondylosis, 2 with single-segment lower cervical spine instabil ity, 4 with single-segment cervical spondylosis and lower cervical spine instabil ity, and 5 with cervical disc herniation. Postoperatively, X-ray films were taken regularly to detect the fusion of bone graft and the intervertebral height of fused segment was measured. The symptoms, signs and cervical functions of patient before operation, shortly after operation and during the follow-up period were evaluated by ＂40 score＂ system. And the occurrence of postoperative axial symptom （AS） was assessed with the standard set by Zeng Yan et al. Results All incisions healed by first intention. AS occurred in 1 case 48 hours after operation and was improved from poor to good after symptomatic treatment. No other kind of compl ication was identified or reported during intra-operative and postoperative period. All the cases were followed up for 16-24 months （average 20.5 months）, and fusion was reached in all the intervertebral discs. Evaluated by ＂40 score＂ system, the average score for the cervical spinal cord function before operation, shortly after operation and during the final follow-up period was 26.2, 30.6, and 35.5 points, respectively, indicating there were significant differences between different time points （P 〈 0.05）. During the follow-up period of above 1 year, the average improvement rate was 67.4%. The average intervertebral height before operation, shortly after operation and during the last follow-up period were 1.9, 4.4 and 4.3 mm, respectively, showing there were significant differences between the preoperation and the immediate postoperative and last follow-up periods （P 〈 0.05）. No degeneration of adjacent segment was observed during the follow-up period. Conclusion Using ACIFC in bone graft fusion and internal fixation for degenerative cervical disease is convenient and fast, has wide range of indications with satisfying cl inical effect, and can achieve obvious therapeutic effect in restoring and maintaining cervical intervertebral height.