前路减压椎间桥形融合器ROI-C置入治疗连续双节段脊髓型颈椎病的疗效对比

Contrastive study of the clinical effects of anterior cervical discectomy and fusion with ROI-C in treating two-level cervical spondylotic myelopathy

目的 ：比较颈椎前路减压椎间桥形融合器ROI-C置入与传统钛板联合cage融合固定治疗连续双节段脊髓型颈椎病的临床疗效。方法：回顾性分析2011年1月~2012年12月我科行颈椎前路减压应用ROI-C或传统钛板联合cage融合固定治疗的连续双节段脊髓型颈椎病患者57例,25例患者采用ROI-C作为内置物（A组）,32例患者采用cage和前路钛板作为内置物（B组）,两组患者年龄、性别比、术前JOA评分、术前颈痛VAS评分及手术节段均无统计学差异。比较两组手术时间、术中出血量、术后JOA评分、术后颈痛VAS评分、颈椎生理曲度（Cobb角）、手术节段前凸角、融合率、吞咽困难发生率及邻近节段退变率。结果：A组手术时间141.3±49.9min,术中出血量123.6±54.1ml,B组分别为168.3±44.4min和126.2±32.6ml,A组手术时间低于B组（P〈0.05）,两组术中出血量相比差异无统计学意义（P〉0.05）。术后3个月及末次随访时,两组JOA评分均显著高于术前水平,差异有统计学意义（P〈0.05）;两组颈痛VAS评分较术前明显下降,差异有统计学意义（P〈0.05）;两组间同时间点JOA及VAS均无显著性差异（P〉0.05）。A组术前、末次随访时颈椎生理曲度分别为12.6°±7.3°、21.9°±6.2°;B组分别为14.3°±9.3°、19.6°±7.3°,两组末次随访时颈椎曲度较术前明显改善,差异有统计学意义（P〈0.05）,两组间同时间点差异无显著性（P〉0.05）。A组术前、末次随访时手术节段前凸角分别为3.4°±5.6°、9.6°±5.5°;B组分别为4.4°±4.3°、9.1°±4.1°,两组手术节段术后前凸角较术前明显增高,差异有统计学意义（P〈0.05）;两组间同时间点比较差异无显著性（P〉0.05）。A组术后有2例诉轻度吞咽困难,吞咽困难发生率8%（2/25）,B组术后有10例诉轻度吞咽困难,1例诉中度吞咽困难,吞咽困难发生率34.4%（11/32）,两组吞咽困难发生率相比差异有统计学意义（P〈0.05）。A组术后3个月手术节段融合率88%（22/25）,B组术后3个月手术节段融合率87.5%（28/32）,末次随访两组手术节段均获得骨性愈合。A组50个邻近节段中有6个节段椎间盘信号发生退变或退变级别加重,B组64个邻近节段中有8个节段椎间盘信号发生退变或退变级别加重,两组邻近节段退变率无统计学差异（P〉0.05）。结论：颈椎前路减压后应用ROI-C固定治疗连续双节段脊髓型颈椎病可以获得与传统cage联合前路钛板固定相似的临床疗效,但使用ROI-C置入具有手术时间短、术后吞咽困难率低等优点。

Objectives： To study the clinical effects of anterior cervical discectomy and fusion（ACDF） by us-ing ROI-C implant via traditional titanium plate with cage in treating two-level adjacent cervical spondylotic myelopathy. Methods： From January 2011 to December 2012, a total of 57 patients with two-level cervical spondylotic myelopathy and undergoing ACDF by ROI-C（group A, n=25） or by titanium plate with cage（group B, n =32） were retrospectively analyzed. There was no statistical significance with regarding to the age, the gender, preoperative JOA scores, preoperative VAS scores of neck pain and surgical level between two groups（P〉0.05）. The operation time, intraoperative blood loss, postoperative JOA scores, postoperative VAS scores of neck pain, cervical physiological curvature（Cobb angle）, segmental lordosis, fusion rate, dysphagia incidence and adjacent segment degeneration rate in both groups were measured and compared. Results： In group A,the operation time was 141.3±49.9min, intraoperative blood loss was 123.6±54.1ml, which was 168.3±44.4min and 126.2±32.6ml in group B respectively, the operation time of group A was significantly lower than group B（P〈0.05）, but there was no statistical significance in intraoperative blood loss between two groups（P〉0.05）.The JOA scores improved significantly after operation in both groups, the VAS scores of neck pain decreased significantly, there were no significant differences on JOA scores and VAS scores of neck pain between two groups at the same follow-up time（P〈0.05）. In group A, preoperative and final follow-up Cobb angle was12.6°±7.3° and 21.9°±6.2° respectively, while 14.3°±9.3° and 19.6°±7.3° in group B, cervical lordosis（Cobb angle） at final follow-up was better than that of preoperation（P〈0.05）, but no significant difference was noted between two groups（P〉0.05）. In group A, preoperative and final follow-up segmental lordosis was 3.4°±5.6°and 9.6°±5.5° respectively, while 4.4°±4.3° and 9.1°±4.1° in group B, segmental lordosis at final follow-up was higher than that of preoperation（P〈0.05）, while no significant difference was noted between two groups（P〉0.05）. In group A, the postoperative dysphagia occurrence rate was 8%, only 2 cases of 25 patients presented with mild dysphagia. In group B, postoperative dysphagia occurred in 34.4% of patients, in 32 patients, mild dysphagia was noted in 10 cases, moderate dysphagia in 1 case. Dysphagia rate in group A was obviously lower than that in group B（P〈0.05）. The fusion rate at the 12 th week after surgery was 88%（22/25） in group A and 87.5% in group B. In addition, bony fusion was obtained in all cases at the final follow-up postoperatively. Among the 50 adjacent levels in group A, 6 discs developed degeneration or progressive degeneration.Among the 64 adjacent levels in group B, 8 discs developed degeneration or progressive degeneration. There was no statistical significance in adjacentlevel degeneration rate between two groups（P〉0.05）. Conclusions：ACDF using ROI-C implant or traditional titanium plate with cage has similar effective treatments for two-level adjacent cervical spondylotic myelopathy, while the ROI-C can carry shorter operation time and a lower risk of postoperative dysphagia.