零切迹颈前路椎间融合系统与颈前路钢板椎间融合系统临床疗效比较

EFFECTIVENESS COMPARISON BETWEEN ANTERIOR CERVICAL ZERO-PROFILE INTERBODY FUSION DEVICE AND ANTERIOR CERVICAL PLATE CAGE BENEZECH

目的 对比研究零切迹颈前路椎间融合系统（Zero-profile interbody fusion device,Zero-P）和颈前路钢板椎间融合系统（plate cage benezech,PCB）治疗颈椎病的效果。方法 2011年2月-2013年1月收治98例颈椎病患者,按随机数字表法分为2组（n=49）,A组采用Zero-P治疗,B组采用PCB治疗。两组患者性别、年龄、病变类型、病程、病变节段等一般资料比较差异均无统计学意义（P〉0.05）,有可比性。比较两组患者后凸Cobb角、简明健康调查量表（SF-36量表）、日本骨科协会（JOA）评分、术后吞咽困难情况、颈椎功能障碍指数（NDI）、疼痛视觉模拟评分（VAS）。结果 A组手术时间及术中出血量均少于B组（t=4.089,P=0.000;t=3.587,P=0.001）。两组患者均获随访,随访时间3～36个月,平均18.5个月。除2例患者于术后3个月发现有1枚螺钉松动、部分脱出并予以重新固定外,其余患者未发现螺钉松动或短路、钢板断裂,未发生植骨塌陷、吸收、脱出、嵌入椎间孔或椎管等并发症。术后6个月内A组出现术后吞咽困难8例（16.33%）,对照组13例（26.53%）,两组比较差异有统计学意义（χ^2=10.616,P=0.001）。末次随访时两组JOA评分、VAS评分、NDI、SF-36量表及Cobb角均较术前显著改善（P〈0.05）。末次随访时,除SF-36量表和Cobb角两组间比较差异无统计学意义（P〉0.05）外,其余指标A组均优于B组（P〈0.05）。末次随访时,A组JOA评分优良率81.63%,B组为71.43%,两组优良率比较差异有统计学意义（χ^2=4.346,P=0.037）。结论 应用Zero-P和PCB治疗颈椎病均可获得较理想效果,但Zero-P创伤小,术后稳定性强,可明显减少术后吞咽困难发生率,对患者生活质量的改善及病情缓解程度均优于PCB。

Objective To compare the effectiveness between anterior cervical Zero-profile interbody fusion device（Zero-P） and anterior cervical plate device（plate cage benezech, PCB） for cervical disease. Methods Between February 2011 and January 2013, 98 patients with cervical spondylosis who accorded with the inclusion criteria were treated with Zero-P in 49 cases（group A） and with PCB in 49 cases（group B）. There was no significant difference in gender, age, disease type, disease duration, and disease segments between 2 groups（P〉0.05）. The Cobb angle, short-form36 health survey scale（SF-36 scale）, Japanese Orthopedic Association（JOA） score, postoperative dysphagia cases, neck disability index（NDI）, and visual analogue scale（VAS） score were compared between 2 groups. Results The operation time and intraoperative blood loss of group A were significantly less than those of group B（t=4.089, P=0.000; t=3.587,P=0.001）. The patients were followed up 3-36 months（mean, 18.5 months）. No loosening or breaking of internal fixation and bone absorption or collapse occurred in the other patients except 2 patients who suffered from screw loosening at3 months after operation. Within 6 months after operation, dysphagia occurred in 8 cases（16.33%） of group A and in 13cases（26.53%） of group B, showing significant difference（χ^2=10.616, P=0.001）. At last follow-up, JOA score, VAS score,NDI, SF-36 scale, and Cobb angle were significantly improved when compared with preoperative ones in 2 groups（P〈0.05）;the other indexes of group A were significantly better than those of group B（P〈0.05） except SF-36 scale and Cobb angle（P〉0.05）. The excellent and good rate of JOA score was 81.63% in group A and 71.43% in group B, showing significant difference（χ^2=4.346, P=0.037）. Conclusion Zero-P and PCB can get good results in treatment of cervical disease, but the Zero-P is better than PCB in reducing postoperative dysphagia because less wounds and strong stability.