前路减压Zero-P椎间融合器治疗颈椎病的疗效

Efficacy of anterior decompression combined with Zero-P interbody fusion device for treating cervical spondylosis

[目的]评价前路减压Zero-p椎间融合器治疗颈椎病临床和影像学结果。[方法]回顾性分析2010年1月~2013年1月接受颈椎前路椎间盘切除融合术（anterior cervical discectomy and fusion,ACDF）联合Zero-p椎间融合器固定治疗颈椎病患者相关资料。临床功能评估采用颈椎功能障碍指数（neck disability index,NDI）、疼痛视觉模拟评分（visual analogue scale,VAS）,影像学评估采用颈椎正侧位X线片,通过Cobb角测量方法,测量病变节段上下椎体Cobb角,测量C_（3~7）椎体颈前软组织厚度,并于术后2年评估融合情况,吞咽困难等并发症也被观察。[结果]共纳入45例患者（50个节段）,27例男性和18例女性,平均年龄（45.64±6.28）岁。所有患者至少随访24个月,平均随访时间为（41.11±7.82）个月。患者术后NDI、VAS评分均较术前有明显改善。影像学上94%的置入物融合。最终随访时颈椎前凸保持良好。术后颈前软组织厚度较术前显著增加,从平均（7.6±1.9）mm增至（15.2±2.9）mm,最终随访时（9.9±1.9）mm。按吞咽困难Bazaz分级,术后吞咽困难发生率44.4%,然而在最终的随访时仍有6.6%的患者具有轻、中度吞咽困难。在术后即刻和最终随访时颈前软组织厚度和吞咽困难分级Pearson相关性分析表明二者呈显著正相关。1例患者术后出现持续性的左上肢疼痛伴左三角肌肌力减弱,1例患者发生声音嘶哑,随访3个月后完全恢复。[结论]颈前椎间盘切除融合术联合Zero-p椎间融合器固定治疗颈椎病可获得较好的临床和影像学结果,术后吞咽困难发生与颈前软组织厚度呈显著正相关。

[ Objective ] To assess the clinical and radiological outcomes in patients with cervical spondylosis treated by an- terior cervical discectomy and fusion （ACDF） using a Zero -profile integrated plate and spacer device. [ Methods] A retro- spective review of 45 patients with cervical spondylosis who underwent ACDF coupled with Zero - p interbody fusion from January 2010 to January 2013 was performed. Clinical evaluation was based on the neck disability index （NDI） and visual analogue scale （VAS） scores, while radiographic parameters included anterior - posterior and lateral X - ray of the cervical spine, and local Cobb angle of operating levelg superior and inferior adjacent segments and prevertebral soft - tissue thickness at C3-7. Bone graft fusion was evaluated 2 years post - operatively, and incidence of complications such as dysphagia was also observed at the follow - up period. [ Results ] Forty - five patients （ 50 segments） were included （ 27 males and 18 females, mean age 45.64 ＋_ 6. 28 years ） in the study. All cases were followed up for at least 24 months （ mean 41.11 ±7. 82 months） . All patients showed signifi- cant improvements in postoperative NDI and VAS scores compared with preoperative scores （ P 〈 0. 05 ） and were well maintained within the follow- up period. Bone graft fusion rate was 94% in all patients at 2 years after surgery. Cervical lordosis was well maintained during the final follow - up. Prevertebral soft - tissue thickness was significantly increased from a mean of 7.6 ± 1.9mm to 15.2 ±2. 9 mm postoperatively, and was maintained at 9.9 ± 1.9 mm during the final follow - up evaluation. According to the Bazaz dysphagia score, the incidence of postoperative dysphagia was 44. 4%, and mild or moderate dysphagia was still found in 6. 6% patients at final follow - up. Pearson correlation analysis showed a significant positive correlation between anterior soft tissue thickness and dysphagia grade immediately after operation and at final follow - up. One patient had persistent left arm pain with reduced left deltoid muscle strength after the operation, and one patient had a hoarse voice and completely recovered 3 months later. [ Conclusion J Treating cervical spondylosis with AC- DF combined with a Zero - profile integrated plate and spacer device produces satisfactory clinical and radiological outcomes. The incidence of postoperative dysphagia is significantly positively correlated with prevertebral soft - tissue thickness.