颈前路零切迹椎间融合内固定系统治疗脊髓型颈椎病的疗效分析

CLINICAL OUTCOME OF ANTERIOR CERVICAL DISCECTOMY AND FUSION USING A ZERO-PROFILE INTERBODY FUSION AND FIXATION DEVICE FOR CERVICAL SPONDYLOTIC MYELOPATHY

目的 探讨颈前路零切迹椎间融合内固定系统（Zero-P）治疗脊髓型颈椎病的疗效。方法 2011年4月-2013年9月,采用颈前路减压Zero-P椎间植骨融合内固定术治疗26例脊髓型颈椎病患者。其中男12例,女14例;年龄43～82岁,平均58.3岁。病程3个月～10年,平均5.9年。病变节段：C3、45例,C4、53例,C5、66例,C6、712例。比较手术前后疼痛视觉模拟评分（VAS）、日本骨科协会（JOA）评分（17分法）、颈椎功能障碍指数（NDI）、颈椎Cobb角及椎间隙高度,评价临床疗效。结果 患者均顺利完成手术,手术时间75～140 min,平均105 min;术中出血量20～150 mL,平均45 mL。未发生手术部位感染、神经损伤、食道瘘、椎前血肿及脑脊液漏等并发症。1例患者术后1周内出现轻度吞咽不适,1个月后症状完全消失。26例均获随访,随访时间12～18个月,平均15.3个月。术后患者临床症状均较术前有不同程度缓解。随访期间无内固定物移位或下沉、螺钉拔出或断裂及颈椎不稳征象。术后3、12个月VAS评分、JOA评分、NDI、椎间隙高度及颈椎Cobb角均较术前显著改善,差异有统计学意义（P〈0.05）;术后3、12个月间比较差异均无统计学意义（P〉0.05）。末次随访时JOA评价获优14例,良10例,中2例,优良率92.3%。结论 颈前路减压Zero-P椎间植骨融合内固定术治疗脊髓型颈椎病,稳定性可靠,可重建颈椎曲度并恢复椎间隙高度,术后吞咽不适发生率低,临床疗效满意。

Objective To analyze the clinical outcome of anterior cervical discectomy and fusion using a Zero- profile interbody fusion and fixation device （Zero-P） for cervical spondylotic myelopathy. Methods Between April 2011 and September 2013, 26 cases of cervical spondylotic myelopathy underwent anterior cervical discectomy and fusion with the Zero-P. Of 26 cases, 12 were male and 14 were female, aged 43-82 years （mean, 58.3 years）. The disease duration was from 3 months to 10 years （mean, 5.9 years）. The involved segments included C3.4 in 5 cases, C4.5 in 3 cases, Cs, 6 in 6 cases, and C6, 7 in 12 cases. The clinical outcome was evaluated using visual analogue scale （VAS） score, Japanese Orthopaedic Association （JOA） score, and Neck Disability Index （NDI） score before operation and after operation. Results The operations were successful and the operation time was 75-140 minutes （mean, 105 minutes）; and blood loss was 20-150 mL （mean, 45 mL）. There was no complications of infection, neural injury, esophageal fistula, prevertebral hematoma, or leakage of cerebrospinal. Dysphagia occurred in 1 case within 1 week after operation, and disappeared after I month. All patients were followed up for an average of 15.3 months （range, 12-18 months）. The clinical symptoms were relieved after operation. During follow-up, no implant displacement or subsidence, screw breakage, and cervical instability were observed. At 3 and 12 months after operation, the VAS score and NDI reduced significantly （P〈0,05）; the ]OA score increased significantly （P〈0.05）; and the intervertebral space height and the cervical Cobb angle improved significantly （P〈0.05）. But there was no significantly difference between at 3 and 12 months （P〉0.05）. According to JOA evaluation, the results were excellent in 14 cases, good in 10 cases, and fair in 2 cases, with an excellent and good rate of 92.3% at last follow-up. Conclusion The clinical outcome of anterior cervical discectomy and fusion using a Zero-P is satisfactory and reliable in the treatment of cervical spondylotic myelopathy. It can restore the cervical physiological curve and the intervertebral space height and decrease the incidence of postoperative dysphagia.