颈椎Zero-P植入与前路减压植骨融合术的对照研究

Comparison Study of Cervical Single Segment Zero-P System with Traditional Anterior Decompression and Fusion

目的 比较颈椎前路植入Zero-P系统手术方式与传统前路减压植骨融合术治疗单节段颈椎病患者的疗效.方法 2010年12月至2012年8月,58例单节段颈椎病患者接受前路Zero-P系统植入手术方式（Zero-P组,31例）或传统前路减压植骨融合术（传统手术组,27例）.比较两种手术方式的手术时间、出血量、住院日、并发症情况,对患者手术前后进行视觉模拟评分（visual analogue scale,VAS）和生活质量量表（Short Form-36,SF-36）的评估.结果 58例患者获得平均11.5个月（6～18个月）随访.Zero-P组及传统手术组的手术时间分别为（76±27） min和（98±21） min,术中出血量分别为（84±41） mL和（123±55） mL,住院日分别为（9±3.3）d和（15±5.1）d,两组差异均有统计学意义（P＜0.05）.术后吞咽不适发生率Zero-P组明显少于传统手术组（P＜0.05）,而硬脊膜撕裂、声音嘶哑等发生率无统计学意义（P＞0.05）.两组患者的颈痛、上肢痛VAS评分,术后各随访点较术前均有改善（P＜0.05）,两组间差异无统计学意义（P ＞0.1）;SF-36躯体、精神评分术后各随访点较术前有明显上升（P＜0.05）,两组间比较,术后3个月内Zero-P组优于传统手术组（P＜0.05）.结论 颈椎前路植入Zero-P系统手术方式治疗单节段颈椎病,与传统前路减压植骨融合术一样能明显改善患者症状,且Zero-P系统操作简便、并发症少,是一种安全有效的颈前路内固定装置.

Objective To prospectively compare the effects of anterior cervical discectomy and fusion （ACDF） using a Zero-profile interbody fusion and fixation device（Zero-P）system with those of ACDF using tradition method in treatment of single cervical disc herniation.Methods From December 2010 to August 2012,a total of 58 patients were enrolled in this study.Thirty-one patients received ACDF with Zero-P device（Zero-P group）and twenty-seven patients underwent ACDF with tradition method（tradition group）.The factors we compared included the operative time,amount of intraoperative bleeding,durationg of hospitalization and some complications.On the other hand,visual analogue scale （VAS）neck/arm pain,Short Form-36 （SF-36） both physical and mental were evaluated pre-and postoperative.Results A total of 58 patients were followed up for an average 11.5 months （range,6 ～ 18 months）.The time of operation was （76 ± 27） min and （98 ± 21） min,the blood loss was （84 ± 41） mL and （123 ± 55） mL,and hospitalization time was （9 ± 3.3） d and （15 ± 5.1） d for Zero-P group and tradition group,which had significant difference （P ＜ 0.05）.The rate of dysphagia was lower in Zero-P group （P ＜ 0.05）,but the incidece of dural tear and hoarseness had no significant difference （P ＞ 0.05）.Both groups showedimproved functional outcomes for VAS scores and SF-36.The improvement in the VAS and JOA scores were equivalent at each follow-up point between the two groups （P ＞ 0.1）.However,Zero-P group had statistically significant improvement as assessed by the SF-36 scores compared with the tradion group in three months postoprative （P ＜ 0.05）.Conclusion The clinical effects of ACDF using Zero-P or tradition method are both satisfactory.The Zero-P system with the advantages of simpler maneuvering and less complications,which is a safe and effective cervical anterior internal fixation device.