Zero-P系统治疗伴骨质疏松的颈椎病疗效分析

Early and Mid-term Outcomes of Zero-Profile Implant in Treatment of Cervical Spondylosis with Osteoporosis

目的 探讨零切迹（Zero-P）颈前路椎间融合内固定系统治疗伴骨质疏松的颈椎病的初中期疗效。方法2010年12月至2013年5月,采用Zero-P系统治疗伴骨质疏松的颈椎病患者18例,其中女性14例,男性4例,包括神经根型颈椎病10例,脊髓型颈椎病6例,混合型颈椎病2例。术前测定骨密度及骨代谢指标,同时比较术前和术后3、12、36个月时颈椎残障功能指数（neck disability index,NDI）评分、日本骨科协会（Japanese orthopaedic association,JOA）评分、颈椎曲度Cobb角、融合节段椎间隙高度及术后吞咽困难发生率。结果 16例为单节段手术,2例为双节段手术,手术顺利,术中无严重并发症发生。手术时间（62±21）min,术中出血量（50.5±22.5）mL。术后随访36~50个月,平均40.1个月,所有患者均达到骨性融合,仅有1例出现融合器下沉,但无任何临床症状。所有患者颈椎功能明显改善,NDI功能评分、JOA评分、颈椎曲度Cobb角及融合节段椎间隙高度术后各个随访时期较术前均明显改善,差异有统计学意义（P〈0.05）。术后3个月时有2例女性患者出现轻度吞咽困难,12个月时完全消失。结论 ZeroP系统用于伴骨质疏松的颈椎病前路手术患者,可以达到满意的植骨融合效果,有效改善颈椎曲度及恢复椎间高度,减少术后吞咽困难发生率,初中期临床疗效满意。

Objective To analyze the early and mid-term efficacy and safety of Zero-Profile implant in treatment of cervical spondylosis with osteoporosis.Methods From December 2010 to May 2013,18 patients underwent anterior cervical operation with Zero-P in treating cervical spondylosis with osteoporosis.There were 10 cases of cervical spondy-lotic radiculopathy,6 of myelopathy and 2 of mixed Type.The NDI score、JOA score、cervical Cobb angle,height of in-tervertebral space of the fusion segment and dysphagia-related symptoms were reviewed respectively at preoperative and 3 months,12 months and 36 months postoperative.Results All 18 cases were followed-up from 36 to 50 months. The surgery lasted an average of 62 min （range,45 to 100 min）,mean blood loss was 50.5mL （range,from 30 to 145 mL）.The sign,neurologic symptom,cervical Cobb angle and height of intervertebral space in all cases had significant improvement.There were 2 of 1 8 patients complained minor dysphagia at 3 month follow-up,but none at 1 2 month. Conclusion The early and mid-term clinical and radiographic efficacy of Zero-P used in treating cervical spondylosis with osteoporosis was satisfactory.The device can improve and maintain the cervical lordosis and height of interverte-bral space.The incidence of postoperative dysphagia was low.