Zero-P颈椎前路融合固定系统在三节段颈椎融合术中的应用及有效性评价

Application of Zero-P cervical anterior fusion fixation system in three-segment cervical fusion and its effectiveness evaluation

目的探讨Zero-P零切迹椎间融合固定系统在三节段颈椎融合术中的临床应用、疗效及其对颈椎曲度的影响。方法选取2013年6月至2015年6月,我院采取Zero-P颈椎前路融合固定系统手术治疗的26例三节段颈椎病的患者。其中男11例,女15例;年龄32~75岁,平均(56.21±8.13)岁。于术前、术后1周、3个月、12个月分别采用日本骨科学会(Japanese orthopaedic association,JOA)评分、颈椎功能残障指数(neck disability index,NDI)评分系统评估临床疗效,Bazaz评分评估术后吞咽困难的发生率,采用手术节段Cobb’s角和C_(2~7) Cobb’s角评估术后颈椎曲度的变化,并对手术出血量、手术时间进行分析统计。结果本组26例均获得术后1年的随访,术后吞咽困难的发生率为7.69%,术中平均出血量为(53.23±32.41)ml,手术时间为(161.26±51.33)min。术后1周、3个月、12个月NDI评分分别为(16.14±1.77)分、(11.53±2.14)分、(11.29±1.82)分,均明显低于术前(23.42±4.72)分,差异有统计学意义(P<0.05),术后1周、3个月、12个月JOA评分分别为(11.52±0.93)分、(12.83±1.18)分、(14.25±1.47)分,均显著高于术前(8.64±1.37)分,差异有统计学意义(P<0.05),术后1周手术节段Cobb’s角(12.74±1.91)°及C_(2~7) Cobb’s角(19.33±4.47)°均较术前(4.52±2.73)°、(7.92±4.20)°明显增大,差异有统计学意义(P<0.05),术后1周与术后12个月比较手术节段Cobb’s角和C__(2~7) Cobb’s角均无明显丢失(P>0.05),随访过程中未发现螺钉断裂及融合器移位。结论 Zero-P颈椎前路融合固定系统治疗三节段颈椎病有较好的临床疗效,并能有效恢复并维持颈椎曲度。

Objective To investigate the clinical effects of Zero-profile anchored spacer（ Zero-p） in the treatment of cervical spondylosis of three segments and its effects on cervical lordosis. Methods From June 2013 to June 2015, 26 patients with three-segment cervical spondylosis were treated by anterior cervical discetomy with implant of Zero-p interbody fusion cages. There were 11 males and 15 females with the mean age of（ 56.21 ± 8.13） years. Japanese Orthopaedic Association（ JOA） was applied to evaluate functions of the cervical vertebra, and the incidence of postoperative dysphagia was assessed by Bazaz dysphagia score. Neck Disability Index（ NDI） was used to evaluate neurological functions. Changes of cervical lordosis were evaluated by C2-7 Cobb＇s angle and Cobb＇s angle of the operative segments. The operation bleeding volume and operation time were analyzed and statistically analyzed. Results All the 26 patients were followed up for 1 year. The incidence of postoperative dysphagia was 7.69%. The average intraoperative blood loss was（ 53.23 ± 32.41） ml and the operation time was（ 161.26 ± 51.33） min. The NDI scores were significantly lower at 1 week（ 16.14 ± 1.77 points）, 3 months（ 11.53 ± 2.14 points） and 12 months（ 11.29 ± 1.82 points） postoperatively comparing with those preoperatively（ 23.42 ± 4.72 points）（ P〈0.05）. The JOA scores at 1 week（ 11.52 ± 0.93 points）, 3 months（ 12.83 ± 1.18 points） and 12 months（ 14.25 ± 1.47 points） were significantly higher postoperatively comparing with those preoperatively（ 8.64 ± 1.37 points）（ P〈0.05）. Cobb＇s angle and C2-7 Cobb＇s angle increased significantly from（ 4.52 ± 2.73） °,（ 7.92 ± 4.20） ° preoperatively to（ 12.74 ± 1.91） °,（ 19.33 ± 4.47） ° 1 week postoperatively（ P〈0.05）. No significant Cobb＇s angle or C2-7 Cobb＇s angle lost were found 12 month postoperatively comparing with those 1 week postoperatively（ P〈0.05）. No screw breakage or fusion cage displacement were found in the follow-up. Conclusions Anterior cervical discetomy with implant of Zero-p interbody fusion cages has good clinical effects in the treatment of cervical spondylosis, and can effectively restore and maintain cervical lordosis.