前路颈椎桥形锁定融合器(ROI-C)治疗退变性颈椎间盘疾病的临床应用分析

Clinical application of anterior cervical interbody fusion cage in treatment of degenerative cervical intervertebral disc diseases

[目的]观察前路颈椎桥形锁定融合器(ROI-C)置入内固定术治疗退变性颈椎间盘疾病的临床疗效。[方法]2011年9月~2013年9月采用颈前路椎间盘摘除、椎管减压、ROI-C椎间融合器植骨融合术治疗退变性颈椎间盘疾病55例(71个节段),其中脊髓型颈椎病31例,神经根型颈椎病24例;单节段45例,双节段10例。评估术前及术后第3、6、12个月患者视觉模拟量表(VAS)评分和日本骨科学会(JOA)评分及放射学检查。记录假体沉降、融合器位置、融合节段Cobb角、融合情况和椎间稳定性以及并发症等。[结果]55例患者中,48例(64个节段)获得最少12个月随访(平均18.1个月)。术前平均椎间隙高度为5.24 mm,术后3 d为7.86 mm,术后12个月为7.64 mm。术后3、6、12个月VAS评分、JOA评分、融合节段Cobb角及椎间隙高度均优于术前,差异有统计学意义(P<0.05)。按VAS评估标准,术后12个月时优32例,良12例,可4例,优良率92%(44/48);按JOA评分标准,术后12个月时优30例,良14例,可4例,优良率92%(44/48)。随访过程中4例发生融合器沉降,1例发生融合器嵌片退出。术后12个月根据颈椎过屈过伸位X线片判断椎间稳定率100%,融合率100%。术后均未发现吞咽困难、伤口血肿、呼吸困难、感染等严重并发症。[结论]颈椎前路ROI-C椎间融合器具有良好的力学稳定性,可有效恢复颈椎生理曲度和椎间隙高度。

[Objective] To investigate the clinical outcomes of anterior cervical interbody fusion cage （ROI-C） for in-ternal fixation in the treatment of degenerative cervical intervertebral disc diseases. [Methods] A total of 55 patients （71 segments） with degenerative cervical intervertebral disc diseases who underwent anterior cervical discectomy, spinal canal de-compression, and bone graft fusion with ROI-C interbody fusion cage in our hospital from September 2011 to September 2013 were enrolled. Among these patients, 31 had cervical spondylotic myelopathy and 24 had cervical spondylotic radiculopathy. Forty-five patients had single-segment lesion, and 10 had double-segment lesion. The visual analog scale （VAS） score, Japanese Orthopedic Association （JOA） score, and radiological findings were evaluated before surgery and at 3, 6, and 12 months after surgery. The prosthesis subsidence, location of fusion cage, Cobb angle of fused segment, fusion status, and inter- vertebral stability were recorded, and the complications were also recorded. [Results] Of all the 55 patients, 48 （64 seg-ments） were followed up for at least 12 months （mean 18.1 months） . The mean disc height was 5.24 mm before surgery, 7.86 mm at 3 days after surgery, and 7.64 mm at 12 months after surgery. The VAS score, JOA score, Cobb angle of fused seg- ment, and disc height were significantly improved at 3, 6, and 12 months after surgery （P 〈0.05） . According to the VAS crite-ria, 32 patients achieved excellent results, 12 achieved good, and 4 achieved fair at 12 months after surgery, resulting in an excellent and good outcomes rate of 92% （44/48） . According to the JOA scoring criteria, 30 patients achieved ex- cellent results, 14 achieved good and 4 achieved fair at 12 months after surgery, resulting in an excellent and good out-comes rate of 92% （44/48） . During the follow-up, 4 patients experienced subsidence of fusion cage and 1 experienced shift of fusion cage. At 12 months after surgery, the cervical X-ray by flexion-extension position showed an intervertebral stability rate of 100% and a fusion rate of 100%. There were no serious complications after surgery, such as dysphagia, wound hematoma, dyspnoea, and infection. [Conclusions ] The anterior cervical ROI-C interbody fusion cage has a good mechanical stability and can effectively restore cervical physiological curvature and disc height.