零切迹自稳型颈椎融合器治疗双节段脊髓型颈椎病的中期临床疗效

Mid-term clinical evaluation of zero-profile anchored spacer for treatment of double-segmental cervical spondylotic myelopathy

目的评价应用零切迹自稳型颈椎融合器(ROI-C)行颈前路椎间盘切除融合术(ACDF)治疗双节段脊髓型颈椎病的中期临床疗效。方法 2012年3月—2014年3月,本院采用ROI-C行ACDF治疗的双节段脊髓型颈椎病患者22例,男16例,女6例;年龄45~76岁,平均58.1岁;C3/C4/C5 3例,C4/C5/C6 11例,C5/C6/C7 5例,C6/C7/T1 1例,C5/C6及C7/T1 1例,C3/C4及C5/C6 1例。采用疼痛视觉模拟量表(VAS)评分评价颈部疼痛程度,日本骨科学会(JOA)评分评价神经功能,Mac Nab标准评价疗效优良率。颈椎侧位X线片测量颈椎生理曲度和融合节段椎间高度,过伸过屈位X线片评价融合相邻节段的椎间活动度(ROM),并对术前及随访时数据进行比较。结果所有手术顺利完成。所有患者随访29~53个月,平均35.3个月。术后3个月VAS和JOA评分均较术前明显改善,差异有统计学意义(P<0.05);末次随访时VAS评分和JOA评分较术后3个月进一步改善,且差异有统计学意义(P<0.05)。术后3个月颈椎曲度和融合节段椎间隙高度均较术前明显改善,差异有统计学意义(P<0.05);末次随访时与术后3个月时相比,差异无统计学意义(P>0.05),颈椎曲度和融合节段椎间隙高度维持良好。末次随访时融合器沉陷率为11.4%。术后3个月相邻节段ROM较术前增加,差异有统计学意义(P<0.05);末次随访时相邻节段ROM较术后3个月进一步增加,且差异有统计学意义(P<0.05)。末次随访时有1例融合上位相邻节段发生椎间隙不稳,但无临床症状。根据Mac Nab标准,疗效优良率为90.9%。随访中未发生术后颈部轴性疼痛、融合器松动等其他并发症。结论应用ROI-C行ACDF治疗双节段脊髓型颈椎病中期随访临床疗效可靠,颈椎生理曲度和融合椎间高度得以有效维持。

Objective To evaluate the mid-term clinical efficacy of double segmental cervical spondylotic myelopathy treated by anterior cervical discectomy and fusion（ACDF） with zero-profile anchored spacer（ROI-C）. Methods From March 2012 to March 2014,22 cervical spondylotic myelopathy patients（16 males,6 females,average age 58.1 years,ranging 45-76 years old） who underwent double segmental ACDF with ROI-C were evaluated. The visual analogue scale（VAS） score was used to assess the degree of neck pain,and the Japanese Orthopaedic Association（JOA） score was used to assess neurological function. MacNab standard was used to evaluate the rate of excellent and good therapeutic efficacy. The cervical curvature,intervertebral space height of fusion segment and range of motion（ROM） of adjacent segments were also evaluated on roentgenograph. The preoperative and follow-up data were compared. Results All operations were completed successfully. The patients were followed up for 29-53 months,mean 35.3 months. Compared with preoperative,the VAS and JOA scores were improved significantly at postoperative 3 months,and the differences were statistically significant（P〈0.05）;Compared with postoperative 3 months,the VAS and JOA scores were improved significantly at final follow-up,and the differences were statistically significant（P〈0.05）. Compared with preoperative,the cervical curvature and intervertebral space height of fusion segment were improved significantly at postoperative 3 months,and the differences were statistically significant（P〈0.05）;but there was no significant difference between the final follow-up and postoperative 3 months（P〉0.05）. The cervical curvature and intervertebral space height of fusion segment were maintained well,and the cage subsidence rate was 11.4%. Compared with preoperative,ROM of adjacent segments was increased at postoperative 3 months,and the difference was statistically significant（P〈0.05）;Compared with postoperative 3 months,ROM of adjacent segments was increased at final follow-up,and the difference was statistically significant（P〈0.05）. At final follow-up,there was 1 patient with intervertebral instability at adjacent segments,but no clinical symptoms. According to MacNab standard,the excellent and good rate was 90.9%. No other complications such as cervical axial pain and loosening of the fusion cage occurred in the follow-up. Conclusion Double-segmental cervical spondylotic myelopathy treated by ACDF with ROI-C has a good mid-term clinical efficacy,and patient＇s cervical physiological curvature and the height of the fusion segment could be effectively maintained.