颈椎动态稳定器联合Cage融合治疗双节段颈椎间盘突出症的临床研究

CLINICAL RESEARCH OF DYNAMIC CERVICAL IMPLANT AND CAGE FUSION IN TWO-LEVEL CERVICAL DISC PROTRUSION

目的探讨使用颈椎动态稳定器（dynamic cervical implant，DCI）联合Cage融合术治疗双节段颈椎间盘突出症的安全性及临床疗效。 方法2009年9月－2011年6月，应用DCI非融合术联合Cage融合术治疗双节段颈椎间盘突出症16例。其中男10例，女6例；年龄37～64岁，平均44.1岁。病程2～8年，平均5.1年。脊髓型颈椎病8例，神经根型颈椎病5例，混合型（脊髓型和神经根型）3例。影像学检查提示椎间盘退变，压迫神经或脊髓。病变节段：C3、4、C4、5 1例，C3、4、C5、6 5例，C4、5、C5、6 3例，C4、5、C6、7 5例，C5、6、C6、7 2例。采用颈椎残障功能指数（NDI）评分、日本骨科协会（JOA）评分及疼痛视觉模拟评分（VAS）评价颈部功能、脊髓功能及疼痛改善情况；术后随访观察DCI稳定性、DCI手术节段活动度、Cage融合状态及Cage移位等情况。 结果术后患者切口均Ⅰ期愈合，无血肿、感染、脑脊液漏、神经功能损害等并发症发生。16例均获随访，随访时间6～36个月，平均18个月。患者颈椎X线片示，末次随访时DCI手术节段活动度为（7.8 ± 3.1）°，与术前（7.3 ± 2.6）°比较差异无统计学意义（t=0.655，P=0.132）。DCI假体无不稳或松动；1例（C4、5）植入DCI假体的椎间隙后缘出现轻度异位骨化。Cage植骨融合椎间隙均未见明显透亮线，无Cage松动下陷，骨性愈合良好，愈合时间3～8个月，平均4.5个月。末次随访时患者NDI评分、JOA评分及VAS评分分别为（18.3 ± 5.1）、（15.7 ± 1.5）、（3.4 ± 1.8）分，与术前的（49.6 ± 11.3）、（12.8 ± 2.0）、（6.7 ± 1.2）分相比均显著改善（t=2.131，P=0.016；t=3.126，P=0.024；t=6.102，P=0.038）。 结论应用DCI非融合与Cage融合联合治疗双节段颈椎间盘突出症，保留了颈椎的运动功能和稳定性，其早期临床效果满意。

Objective To discuss the safety and effectiveness of combined dynamic cervical implant （DCI） and Cage fusion in the treatment of two-level cervical disc protrusion. Methods Between September 2009 and June 2011, 16 cases of two-level cervical disc protrusion were treated with combined DCI and Cage fusion. Of 16 cases, 10 were male and 6 were female, with a mean age of 44.1 years （range, 37-64 years） and with a mean disease duration of 5.1 years （range, 2-8 years）, including 8 cases of cervical myelopathy, 5 cases of nerve root cervical myelopathy, and 3 cases of mixed cervical myelopathy. Radiological results indicated degenerative intervertebral discs and compressed never root or spinal cord. Involved discs included C3, 4 and C4, 5 （1 case）, C3, 4 and C5, 6 （5 cases）, C4, 5 and C5, 6 （3 cases）, C4, 5 and C6, 7 （5 cases）, and C5, 6 and C6, 7 （2 cases）. The neck disability index （NDI）, Japanese Orthopedic Association （JOA） score, and visual analogue scale （VAS） were used to evaluate the neurological function and pain relief. The stabilities and activities of involved segments, intervertebral fusion, and displacement of Cages were observed during follow-up. Results Primary healing of incisions was obtained in all cases; no complication of hematoma, infection, cerebrospinal fluid leakage, or neural function damage occurred. All 16 patients were followed up 18 months on average （range, 6-36 months）. The cervical X-ray results indicated that the activities of involved segments was （7.8 ± 3.1）°, showing no significant difference （t=0.655, P=0.132） when compared with preoperative value [（7.3 ± 2.6）°]. No implant loosening was observed; slight heterotopic ossification occurred in 1 patient at the posterior rim of intervertebral space. No cage loosening or sinking was seen, and good fusion was achieved. The mean time of fusion was 4.5 months （range, 3-8 months）. NDI, JOA, and VAS scores at last follow-up （18.3 ± 5.1, 15.7 ± 1.5, and 3.4 ± 1.8 respectively） were significantly improved （t=2.131, P=0.016; t=3.126, P=0.024; t=6.102, P=0.038） when compared with preoperative scores （49.6 ± 11.3, 12.8 ± 2.0, and 6.7 ± 1.2 respectively）. Conclusion A combination of DCI and intervertebral Cage fusion has satisfactory early effectiveness in treatment of two-level cervical intervertebral protrusion for maintaining the stability and activity of cervical vertebrae.