微创小切口零切迹颈前路椎间融合器治疗单节段脊髓型颈椎病的疗效评价

Effect of stand-alone zero profile anterior cervical interbody fusion cage in treating of the single segmental cervical spondylotic myelopathy with anterior mini-incision

[目的]探讨新型零切迹颈前路椎间融合器(zero profile anterior cervical interbody fusion cage,ACIFC)单独应用于单节段脊髓型颈椎病(cervical spondylotic myelopathy,CSM)微创小切口治疗的手术特点和近期临床疗效。[方法]对收治的43例中老年单节段CSM患者采用颈椎前路横行小切口,椎间盘髓核摘除、减压、ACIFC单独置入植骨融合内固定术,分析手术特点,对比手术前后、末次随访的临床疗效(VAS和JOA评分)及影像学融合节段椎间隙高度、Cobb角变化,判断椎间稳定性及椎间融合率。[结果]手术时间(55±10)min;术中失血(35±10)ml。住院时间(5.2±1.2)d,术后吞咽困难发生率2.3%。术后随访(18.5±4.5)个月(13～26个月),43例患者术前VAS评分(6.5±1.5)分,JOA评分9.2±1.7分,末次随访VAS评分(1.2±0.8)分,JOA评分(15.6±1.8)分,JOA评分术后:优23例,良15例,可4例,差0例,优良率90.7%。术后1周和末次随访与术前相比融合节段椎间隙高度和Cobb角明显改善(P<0.01),术后1周与末次随访比较无明显间隙高度和角度丢失(P>0.05),随访过程中未发现融合器及内固定螺钉松动、移位,末次随访颈椎过屈、过伸位X线片判断椎间稳定率100%,X线片判断椎间融合率65.1%(28/43)。[结论]ACIFC单独应用于单节段CSM微创小切口治疗的手术创伤小,操作简单,并发症低,住院时间短,达到微创化手术效果,可有效改善和维持颈椎的病变节段生理曲度和椎间隙高度,有良好的力学稳定性能,临床近期疗效满意。中远期疗效需进一步随访评估。

[ Objective ] To observe the clinical effect of Stand-alone Zero profile anterior cervical interbody fusion cage （ACIFC） in treating of the single segmental cervical spondylotic myelopathy（CSM） with anterior mini-incision and analyze its operative characteristics. [ Method] Forty-three patients with single segmental CSM were treated by anterior decompression,im- plantation of ACIFC with anterior mini incision. Clinical outcome according to VSA and JOA scoring system, lordosis angle of cervical spine and intervertebral space angle and height on radiographs were recorded pre and postoperatively. [ Result] All pa- tients were followed up for an average of 18.5 ±4.5 months（ 12 to 26 months） and achieved 65.1% （28/43）bone fusion within the follow-up period. The average VAS score decreased from 6.5 ± 1.5 preoperatively to 1.2 ± 0.8 at the final follow-up and the average JOA score increased from 9.2 ± 1.7 preoperatively to 15.6 ± 1.8 at the final follow-up. The good to excellent results rate was 90.7%. The intervertebral height and Cobb angle in the immediate postoperative and the last follow-up were significant- ly increased compared to preoperation（ P 〈0.01 ） ,but no significantly changes between them（ P 〉 0.05 ）. [ Conclusion] Standalone ACIFC in treating of the single segmental CSM is a good technique which can effectively maintain the physiological verte- bral lordosis and intervertebral height, provide long time stability and achieve satisfactory clinical results with less injury.