自锁式颈椎前路椎间融合治疗单间隙脊髓型颈椎病

Treatment of self-locking stand-alone anterior cervical interbody fusion for patients with single level cervical spondylotic myelopathy

目的：探讨自锁式颈椎前路椎间融合器治疗单椎间隙脊髓型颈椎病（CSM）的近期临床疗效。方法2010年3月至2011年12月广州军区广州总医院采用颈椎前路椎间盘髓核摘除、减压、自锁式椎间融合器植骨融合术治疗单间隙CSM患者39例，其中C3/410例、C4/517例、C5/612例。记录手术时间、术中失血量、住院时间及并发症发生情况；评估术前及术后3、6、12个月患者视觉模拟量表（VAS）评分和日本骨科学会（JOA）评分；同时测量手术前后融合节段Cobb角和椎间隙高度，判断椎间稳定性。结果手术时间（50±10）min，术中失血量（30±5）mL，住院时间（4.9±1.2）d，术后均未发现吞咽困难、伤口血肿、呼吸困难等并发症。39例患者获得随访，随访时间13～26个月（平均17.5个月）。术后3、6、12个月VAS评分、JOA评分、Cobb角及椎间高度均优于术前，差异有统计学意义（P＜0.05）。按VAS评估标准，术后12个月随访时优27例、良10例、可2例，优良率95%（37/39）；按JOA评分标准，术后12个月随访时优21例、良15例、可3例，优良率92%（36/39）。随访过程中未发现融合器移位、下沉、断裂，术后12个月颈椎过屈过伸位X线片判断椎间稳定率100%。结论自锁式颈椎前路椎间融合器具有良好的力学稳定性，可有效恢复颈椎生理曲度和椎间隙高度，治疗单间隙CSM具有手术创伤小、操作简单、并发症少、住院时间短等优点，椎管减压效果确切，临床症状获得有效改善。

Objective To explore short-term clinical efficacy of self-locking stand-alone anterior cervical interbody fusion （ACIF） cage for the treatment of single level cervical spondylotic myelopathy （CSM）. Methods From March 2010 to December 2011, 39 patients with single level CSM （C3/4 in 10 cases, C4/5 in 17 cases and C5/6 in 12 cases） were performed anterior cervical discectomy, decompression, and autologous bone graft fusion with ACIF cage in Guangzhou General Hospital of Guangzhou Military Command. Operation time, intraoperative estimate blood loss, hospital stay and complications were recorded;At preoperation and 3, 6, 12 months after the surgery, visual analogue scale （VAS） and Japanese Orthopaedic Association （JOA） scores were evaluated, at the same time, Cobb angle as well as intervertebral height at fusion segments were measured. Results The operation time was （50 ± 10） min, intraoperative estimate blood loss was （30 ± 5） mL, and the duration of hospitalization was （4.9 ± 1.2） d. No postoperative dysphagia, wound hematoma, dyspnoea were found. All patients were followed up, with the average time of 17.5 months （13 to 26 months）. Compared with VAS score, JOA score, Cobb angle and intervetebral height at preoperation, those at 3, 6, 12 months after the surgery had improved, the differences showed statistical significance （P 〈0.05）. At 12 months’follow-up, there were excellent in 27 cases, good in 10 cases, fair in 2 cases, with the excellent and good rate of 95% （37/39） according to VAS evaluation standard;As for JOA score, there were excellent in 21 cases, good in 15 cases, fair in 3 cases, with the excellent and good rate of 92% （36/39）. During the follow-up, no cage shift, sink or breakage had been observed. At 12 month after the surgery, cervical X-ray by flextion-extension position showed that intervertebral stabilization rate was almost 100%. Conclusions With good mechanical stability, self-locking ACIF cage could effectively restore cervical physiological lordosis and intervetebral height. For single level CSM patients, the treatment of ACIF has the advantages of less surgical injury, simple procedure, short hospital stay, which could obtain sufficient spinal canal decompression and improve clinical symptoms.