选择性连续三节段Solis融合器置入对颈椎曲度的长期影响

Long-term influence of selective consecutive three-level appliance of Solis cage on cervical curvature

背景:随着对颈椎疾病病理过程认识的深入,颈椎曲度日渐成为评价长期临床疗效的重要指标之一。恢复及保持颈椎正常生理曲度对维持颈椎远期稳定性及颈椎生物力学环境有重要意义。目的:评价选择性颈椎前路连续三节段Solis椎间融合器治疗脊髓型颈椎病对颈椎曲度的长期影响。方法:2008年6月至2010年12月应用Solis融合器行选择性连续三节段颈前路手术治疗脊髓型颈椎病共22例,男14例,女8例,年龄26-73岁,平均45.1岁。C2/3/4/5,C3/4/5/6,C4/5/6/7,C5/6/7/T1分别为2,7,12,1例,共66个椎间隙。所有患者均随访2年以上。结果与结论:平均出血量40 mL(20-80 mL),平均手术时间121 min(100-175 min)。平均随访30.7个月,手术节段均骨性融合,无植入物移位或椎体塌陷。置入前JOA评分为11.94±3.61,置入后6个月为15.56±1.13,置入后2年为15.21±1.85;置入前颈椎曲度为(1.86±3.24)mm,置入后6个月为(4.83±1.78)mm,置入后2年为(4.44±3.36)mm。以上各组数据置入前与置入后6个月,置入前与置入后2年间差异均有显著性意义(P<0.05),置入后6个月与置入后2年间差异均无显著性意义(P>0.05)。结果显示行颈椎前路连续三节段椎间融合器置入治疗脊髓型颈椎病可有效改善颈椎曲度并长期维持,有良好的临床疗效。

BACKGROUND： With the understanding of pathology of cervical diseases, cervical curvature has become one of the important indexes of long-term clinical outcome. To restore and maintain cervical curvature has a profound impact on cervical long-term stabilization and cervical biomechanical environment. OBJECTIVE： To evaluate long-term influence of selective consecutive three-level appliance of intervertebral Solis cage on cervical curvature for spondylotic myelopathy. METHODS： From June 2008 to December 2010, 22 spondylotic myelopathy patients were treated with consecutive three-level anterior cervical Solis fusion. There were 14 males, 8 females, with an average age of 45.1 years（ranged from 26-73 years）. There were two cases of C2/3/4/5, seven cases of C3/4/5/6, 12 cases of C4/5/6/7, and one case of C5/6/7 /T1, totally 66 intervertebral spaces. All cases were followed up for 2 years. RESULTS AND CONCLUSION： Average blood loss amount was 40 mL（20-80 mL）. Average operation time was 121 minutes（100–175 minutes）. After follow-up for 30.7 months, all segments were fused. There was no implant migration or vertebral body collapse. Pre-operative JOA score was 11.94±3.61, 15.56±1.13 at 6 monthspost-operation, and 15.21±1.85 at 2 years after implantation. Pre-operative cervical curvature was（1.86±3.24） mm,（4.83±1.78） mm at 6 months post-operation, and（4.44±3.36） mm at 2 years after implantation. There were significant differences between pre-operative and at 6 months post-operation, pre-operative and at 2 years post-operation（P 0.05）. There was no significant difference between 6-month and 2-year post-operation（P 0.05）. Results indicated that selective consecutive three-level appliance of intervertebral cage for spondylotic myelopathy could improve cervical curvature and have long-term favorable clinical outcomes.