两种颈前路减压融合内固定系统治疗颈椎病的疗效比较

Effect of Two Kinds of Anterior Cervical Decompression and Fusion Methods for Cervical Spondylosis

目的比较传统钛板联合Cage融合内固定(A组)与零切迹椎间融合(B组)治疗颈椎病的疗效。方法回顾性分析我院2012年7月至2014年6月采用前路减压植骨融合内固定治疗的48例颈椎病患者的临床资料,其中使用传统钛板联合cage植骨融合内固定24例(A组),使用Zero-P椎间融合器植骨融合内固定24例(B组)。比较两组手术时间、术中出血量、日本骨科协会(Japanese orthopaedic association,JOA)评分、颈椎功能障碍指数(neck disability index,NDI)评分,Bazaz吞咽困难分级,测量颈椎曲度、相邻椎体角度位移及水平位移。结果两组手术时间、术中出血量比较差异无统计学意义(P>0.05),两组患者的JOA与NDI末次评分均较术前显著改善(P<0.05),两组间比较差异无统计学意义(P>0.05),Bazaz吞咽困难分级两组间差异有统计学意义(P<0.05)。术后两组颈椎曲度较术前显著增加(P<0.05)。术后6个月和末次随访,A组的角度位移和水平位移均大于B组,两组比较差异有统计学意义(P<0.05)。结论两种融合方式均能获得良好的临床症状改善,但在减少吞咽困难、相邻节段退变方面,Zero-P系统具有一定优势。

Objective To compare the clinical effects between traditional titanium plate with cage（group A）and Zero-P（group B）in treating cervical spondylosis.Methods The clinical data of 46 patients with cervical spondylotic myelopathy who underwent anterior cervical discectomy and fusion（ACDF）by traditional titanium plate with cage（group A,n=24）or Zero-P implant（group B,n=24）between July 2012 and June 2014 were retrospectively analyzed.The operation time,intraoperative blood loss,postoperative JOA scores,NDI score,Bazaz dysphagia score,cervical curvature,vertebral angle displacement and horizontal displacement were compared between groups.Results There was no statistical significance in terms of operation time and blood loss between group A and B（P〉0.05）.The JOA score,NDI score of the last follow-up was significant improved（P〈0.05）,but no statistical difference was found between both groups（P〉0.05）.The cervical curvature showed significantly increases after operation（P〈0.05）,Bazaz dysphagia score between the two groups was statistically significant（P〈0.05）.The cervical curvature,angle displacement and horizontal displacement were significantly higher in group A than in the group B at 6months and final follow-up.Conclusion Zero-P implant and traditional titanium plate with cage have similar effective treatments for cervical spondylosis,while Zero-P implant has lower incidence of dysphagia and adjacent segment degeneration.