前路减压联合零切迹椎间融合固定系统治疗脊髓型颈椎病疗效分析

Curative efficacy analysis of anterior cervical decompression combined with zero-profile interbody fusion system for cervical spondylotic myelopathy

目的分析经前路减压联合零切迹椎间植骨融合固定系统(Zero-P)治疗脊髓型颈椎病的疗效。方法 41例脊髓型颈椎病患者行颈前路减压联合Zero-P植骨融合内固定手术,其中单节段39例,2个节段2例,共植入Zero-P 43个,手术节段C3/4、C4/5、C5/6、C6/7、C7/T1椎间隙各置入Zero-P为5、11、17、8、2个。采用日本骨科学会(JOA)评分及Odom等级标准评定手术疗效,并观察患者术后并发症及植骨融合情况。结果 41例患者平均手术时间为(73.7±11.6)min,术中平均出血量为(60.0±5.1)mL,术后均无吞咽困难、切口感染、神经损伤及气管、食管损伤。平均随访(17.3±3.4)个月,随访期间未发现内固定松动断裂、手术节段椎体不稳及椎体高度丢失,患者术后脊髓功能均得到明显改善。术前JOA评分为8.76±1.15,而术后1个月、末次随访JOA评分分别为12.16±1.07、14.37±1.21,均较术前有明显改善,差异有统计学意义(P<0.05);末次随访按Odom评分标准优32例,良7例,可2例,优良率为95.1%,植骨融合率为100.0%。结论颈前路减压联合Zero-P治疗脊髓型颈椎病疗效满意,Zero-P具有操作简便、融合可靠、并发症少等优点,是一种理想的内固定方法。

Objective To analyze the clinical efficacy of anterior cervical decompression combined with zero-profile in- terbody fusion system（Zero-P） for cervical spondylotic myelopathy. Methods A total of 41 patients with cervical spondylotic myelopathy who underwent anterior cervical decompression combined with Zero-P interbody fusion and internal fixation were selected,including 39 patients with monosegmental and 2 patients with bisegmental disc disease. A total of 43 Zero-Ps were im- planted,the number of Zero-Ps implanted in the segment C3/4, C4/5, C5/6, C6/7 and C7/T1 was 5,11,17,8 and 2 respec- tively. Japan Orthopedic Association （JOA） score and Odom grade standard were used to evaluated surgical treatment efficacy, and the postoperative complications and bone graft fusion were observed. Results The average of operation duration was （73.7 ±11.6） min and intraoperative blood loss was （60.0 ± 5.1 ） mL. There was no dysphagia,wound infections, nerve inju- ry, trachea and esophagus injury after operation. The follow-up average time was （ 17.3 ± 3.4） months and there was no fixa- tion-related complications such as fixator loosening and breakage, vertebral instability, vertebral body heigh during follow-up time. The spinal cord function improved significantly. The JOA score improved significantly（ P 〈0.05 ） ,from 8.76 ± 1.15 be- fore operation to 12. 16± 1.07 of one month follow-up and 14.37 ± 1.21 of the last follow-up time. According to Odom stand- ard, excellent outcome was seen in 32 cases, good in 7 cases, fair in 2 cases. The excellent and good rate was 95.1% and the bone graft fusion rate was 100.0%. Conclusion The clinical efficacy of anterior cervical decompression combined with Zero- P for cervical spondylotic myelopathy is satisfactory and reliable. Zero-P has easy operation, reliable integration, fewer compli- cation and other advantages. It is an ideal internal fixation method.