颈椎前路钢板与零切迹系统治疗多节段伴后凸畸形颈椎病

Comparison of ACDF with Zero-P and Cages with Plate in Treatment of Multiple-level Cervical Spondylosis with Cervical Kyphosis

目的评价颈前路零切迹椎间融合器(Zero-Profile interbody fusion device,Zero-P)与颈椎前路钢板联合cage治疗多节段颈椎病伴后凸畸形的临床疗效,探讨两种治疗方法对颈椎后凸畸形矫形的影响。方法回顾性分析2012年8月至2016年3月我院治疗的多节段伴后凸畸形颈椎病患者的临床资料。其中A组23例行椎间隙减压Zero-P固定。B组22例行椎间隙减压颈椎前路钢板固定cage植入术。根据患者颈椎Cobb角、椎间高度变化情况比较其矫形效果,根据患者手术前后日本骨科协会(Japanese orthopaedic association,JOA)评分、视觉模拟评分(visual analogue scale,VAS)、颈椎残障功能指数(neck disability index,NDI)比较其临床效果,同时比较两种治疗方法在并发症方面的差异。结果所有患者均获得随访,A组平均24.7个月,B组平均25.2个月;随访期间未发现有内固定物松动、螺钉断裂及相邻节段退化等并发症。末次随访时,所有患者内固定均稳定在位,椎间均有不同程度的骨性融合。两组患者术后及末次随访时,患者JOA评分、VAS评分、NDI指数、颈椎Cobb角及椎间隙高度均较术前有明显改善,差异有统计学意义(P<0.05)。两组患者术前资料对比及术后资料对比,差异均无统计学意义(P>0.05)。结论对于伴有后凸畸形的多节段颈椎病患者行颈椎前路减压Zero-P固定及传统钢板固定均可以获得良好的治疗效果。

Objective To evaluate the clinical outcomes and complications of ACDF with Zero-P and cages with plate in treating multiple-level cervical spondylosis （MCS） with cervical kyphosis.Methods Clinical data of patients with MCS caused by degenerative disc herniation were retrospectively analyzedfrom August 2012 to March 2016.Clinical parameters including Japanese orthopedic association （JOA）score,neck disabled index（NDI） and visual analogue scale（VAS） were evaluated.The orthopaedic effect of Zero-P and cages with plate were investigated according to changes of the cervical Cobb angle and intervertebral space height.Results All patients were followed up for an average of 24.7 months in Group A and 25.2 months in Group B.45 cases of patients＇ main symptoms were significantly reduced.There was no serious complications.Postoperative symptoms improved with time.The JOA score,the VAS score,the NDI index,the cervical intervertebral height and the Cobb angle one month after operation and during last follow-up were improved significantly compared with the preoperative data.The differences were statistically significant（P〈0.05） in Group A and Group B.But the differences between Group A and Group B were not statistically significant（P〈0.05）.Conclusion Based on the follow-up,Anterior cervical decompression and fusion with Zero-P and cages with plate could achieve good effect in treating multilevel cervical spondylotic myelopathy with kyphosis.