零切迹椎间融合内固定系统Zero-P在颈椎前路手术中的应用

The application of zero profile interbody fixation and fusion system for the anterior cervical spine surgery

目的探讨零切迹椎间融合内固定Zero-P系统在颈椎前路手术中的应用疗效。方法 2010年11月至2012年1月广州军区广州总医院收治36例颈椎退变性疾病患者,均行前路减压、Zero-P椎间融合内固定手术,其中脊髓型颈椎病27例、神经根型颈椎病9例。采用日本骨科协会(JOA)评分法评价患者手术前后的神经功能,观察患者术后影像学变化以评价植骨融合情况。结果手术均顺利完成,34例患者置入1枚、2例置入2枚Zero-P零切迹椎间融合器。全部病例获随访4～17个月(平均10.6个月)。术后即刻及末次随访JOA评分较术前均有明显改善(P<0.05);末次随访JOA评分优16例、良13例、可7例,优良率为81%。均获得植骨融合,融合时间3.5～7.0个月(平均4.8个月)。随访期间未出现内固定物松动、断裂、金属过敏等器械相关并发症;6例(17%)患者术后出现吞咽困难,其中5例于1周至1.5个月后症状消失,仅1例末次随访时症状仍存在。结论零切迹椎间融合内固定Zero-P系统是颈椎前路手术较好的内固定选择,可有效减少术后吞咽困难并发症的发生。

Objective To study the outcome of clinical application of zero profile interbody fixation and fusion system for anterior cervical spine surgery. Methods From November 2010 to January 2012, 36 cases with cervical degenerative diseases in Guangzhou General Hospital of Guangzhou Military Command were treated with zero profile interbody fixation and fusion system following anterior cervical decompression, including 27 cases with cervical spondylotic myelopathy and 9 cases with cervical spondylotic radiculopathy. The pre- and postoperative neurological functions were evaluated by Japanese Orthopaedic Association （JOA） scores, and the bone graft and fusion conditions were assessed by postoperative radiographs. Results Thirty-four cases with single-level operation and 2 cases with two-levels operation were perfomled successfully. The mean follow-up for all cases was 10.6 months （range, 4 to 17 months）. JOA scores at postoperation and the last follow-up improved compared with preoperative ones （P 〈0.05） According to JOA scores at the last follow-up, there were excellent in 16 cases, good in 13 cases, lair in 7 cases, with the excellent and good rate was 81% at the last follow-up. All cases achieved bony fusion with the average of 4.8 months （range, 3.5 to 7.0 months）. There were no fixation-related complications such as fixator loosening, breakage and metal allergy. Postoperative dysphagia were found in 6 patients with the incidence was 17%. Five patients recovered after 1 week to 1.5 months, while 1 case still had the symptom at the last follow-up. Conclusion profile interbody fixation and fusion system is a good choice for anterior cervical spine surgery which could the incidence of postoperative dysphagia effectively The zero decrease