新型Zero-P与cage钛板椎间融合器修复颈椎病:早期稳定性对比

Novel Zero-P versus titanium plate with cage interbody fixation and fusion system in repairing cervical spondylosis:early stability

背景:颈前路椎间盘切除减压植骨融合修复颈椎病效果显著,但有颈椎不稳、融合率低等缺点,cage钛板融合器可以弥补这些缺点,但仍有颈前异物感、吞咽困难等并发症发生。一种新型兼有支撑、固定节段椎体的一体式椎间融合器Zero-P广泛在临床应用。目的:观察使用新型零切迹椎间融合内固定系统Zero-P修复颈椎病的早期稳定性,并与cage钛板椎间融合器进行比较。方法:回顾性分析江苏大学附属医院骨科2010年8月至2014年8月收治31例颈椎病患者行颈前路减压植骨融合内固定治疗的临床数据,根据使用的融合器分为2组,Zero-P融合器组15例,cage钛板组16例。分别记录并对比手术时间、术中出血量、治疗前后目测类比评分、日本矫形外科学会评分、治疗后吞咽困难发生率以及邻近关节的退变率。结果与结论:12组患者治疗后症状均明显改善,无严重并发症;2Zero-P融合器组的手术时间、术中出血量均优于cage钛板组(P<0.05);32组治疗后目测类比评分和日本矫形外科学会评分均较治疗前改善,差异有显著性意义(P<0.05);Zero-P融合器组与cage钛板组的日本矫形外科学会评分恢复率相似(81%,81%,P>0.05);4Zero-P融合器组1例(7%)有轻度吞咽困难,cage钛板组7例(44%)有吞咽困难症状,两组治疗后吞咽困难发生率差异有显著性意义(P=0.037);两组之间邻近关节退变率差异无显著性意义(P=0.48);5结果提示颈前路减压植骨融合过程中,新型Zero-P融合器及cage钛板都是修复颈椎病的有效方式,但Zero-P融合器吞咽困难发生率更低,稳定性更好。

BACKGROUND：It is notable to treat cervical spondylosis using the anterior cervical discectomy and fusion,but there are such complications as cervical instability and low fusion rate.Titanium plate with cage can solve those defects,while anterior unfamiliar matter and dysphagia appear.A new anterior cervical interbody fusion Zero-P with support and fixation function has been widely used in clinic.OBJECTIVE：To analyze early stability in repairing cervical spondylosis using a new Zero-P interbody fixation and fusion system,and compare with a titanium plate with cage interbody fixation and fusion system.METHODS：We retrospectively analyzed the clinical date of 31 patients with cervical spondylosis who underwent the anterior cervical discectomy and fusion in the Department of Orthopedics,Affiliated Hospital of Jiangsu University between August 2010 and August 2014.Fifteen patients were treated with a Zero-P implant（Zero-P group） and sixteen patients with a titanium plate with cage（cage group）.We recorded operation time,intraoperative blood loss,preoperative and postoperative Visual Analogue Scale scores and Japanese Orthopedic Association scores,postoperative incidence of dysphagia and degeneration rate of adjacent joint.RESULTS AND CONCLUSION：（1） Postoperative symptoms were apparently improved,without severe complications in both groups.（2） Operation time and intraoperative blood loss were better in the Zero-P group than in the cage group（P〈0.05）.（3） Postoperative Visual Analogue Scale scores and Japanese Orthopedic Association scores were significantly improved in both groups（P〈0.05）.The recovery rate of Japanese Orthopedic Association scores was similar between the two groups（81%,81%;P〉0.05）.（4） Mild dysphagia was experienced by one case（7%） in the Zero-P group,but nine cases（44%） in the cage group.Significant difference in the incidence of dysphagia was detected between the two groups after treatment（P=0.037）.However,no significant difference in degeneration rate was detectable between the two groups（P=0.48）.（5） These findings verify that in the anterior cervical discectomy and fusion,the new Zero-P and titanium plate with cage interbody fixation and fusion system are effective choices for cervical spondylosis.However,the Zero-P interbody fixation and fusion system showed a low incidence of postoperative dysphagia and better stability.