融合与非融合固定治疗脊髓型颈椎病:谁更易于椎体的活动度及稳定性?

Fusion and non-fusion fixation for cervical spondylotic myelopathy:which is more appropriate for maintaining range-of-motion and stability of vertebrae?

背景:近年来,许多国内外学者采用联合非融合及融合固定治疗多节段脊髓型颈椎病,取得良好临床效果,但相关远期临床疗效及可能出现的并发症还需要长期的随访进行更深入的研究。目的:综述颈椎前路融合与非融合内固定2种方式在治疗脊髓型颈椎病中的研究与应用进展。方法:由第一作者用计算机检索2004年1月年至2014年1月中国期刊全文数据库和美国PubMed数据库中有关于前路融合、非融合手术治疗脊髓型颈椎病的文章。中文检索词为"植入物材料;脊髓型颈椎病;前路;手术;融合;非融合;进展;杂交;综述"。英文检索词为"implant material;cervical spondylotic myelopathy;anterior;surgery/operation;fusion;non-fusion;research progress;hybrid;summary"。纳入35篇文章进行综述。结果与结论:颈椎前路融合与非融合固定方式在治疗脊髓型颈椎病时各具优势,从适应证来看,非融合固定方式相对局限。目前,融合固定仍是治疗脊髓型颈椎病的主要方法。非融合固定作为一种新出现的固定方法也取得了良好的近期效果,但其有待于更长时间的随访研究。Hybrid固定可综合上述两者的优势,减压的同时减少了融合节段,尽可能的保留颈椎的活动度,目前已成为研究热点。但是目前关于Hybrid固定的研究大多是回顾性研究,缺乏对照,总体随访时间短,需要进更一步的研究来证实。

BACKGROUND：In recent years, many scholars adopted a joint non-fusion and fusion spinal fixation for multisegmental cervical spondylotic myelopathy, and achieved good clinical results. However, long-term clinical efficacy and possible related complications also require long-term fol ow-up of more in-depth study. OBJECTIVE：To review the research and application progress of anterior fusion and non-fusion fixation surgical operation for cervical myelopathy. METHODS：Computer-based search was conducted in China Journal Ful-text Database and PubMed database by the first author for articles related to anterior fusion and non-fusion fixation surgical operation for cervical myelopathy published between January 2004 and January 2014. The key words were“implant material;cervical spondylotic myelopathy;anterior;surgery;fusion;non-fusion;progress;hybrid;summary”in Chinese and“implant material;cervical spondylotic myelopathy;anterior;surgery/operation;fusion;non-fusion;research progress;hybrid;summary”in English. Final y, 35 articles were included for review. RESULTS AND CONCLUSION：Fusion and non-fusion fixation methods for cervical spondylotic myelopathy had their own advantages. From the view point of indications, the non-fusion fixation was relatively limited. Currently, the fusion fixation was stil the main method in treatment of cervical myelopathy. Non-fusion method as an emerging fixation method also achieved good short-period results, but it needs a long fol ow-up study. Hybrid fixation integrates the advantages of both methods, and can reduce the pressure. Simultaneously, Hybrid fixation＆amp;nbsp;also can reduce fusion segments, and retain the range-of-motion of the cervical spine as much as possible. Hybrid fixation becomes a hot topic in recent studies. However, most current researches on Hybrid fixation are retrospective study, lack of control. The overal fol ow-up time is short. Thus, Hybrid fixation needs to be researched more deeply.