前路颈椎桥形锁定融合器在颈椎间盘切除融合术治疗退变性颈椎病中的应用

Clinical Efficacy of Anterior Cervical Bridge Locking Fusion Cage in the Treatment of Degenerative Cervical Spondylosis with ACDF

目的评价退变性颈椎病行前路颈椎间盘切除融合术(anterior cervical discectomy and fusion,ACDF)中应用前路颈椎桥形锁定融合器的临床疗效。方法回顾性分析自2013年10月至2016年9月,我科应用前路颈椎桥形锁定融合器对104例退变性颈椎病患者行前路椎间减压ROI-C融合固定术,共植入108枚ROI-C。神经根型颈椎病48例,脊髓型颈椎病56例。术后3d、3个月、6个月、12个月定期随访并复查X线片或CT,用JOA、VAS评分评价末次随访时神经功能及疼痛改善情况,记录手术时间、出血量和并发症情况,根据末次随访时颈椎X线片或CT评价椎间隙高度和ROI-C椎间融合情况。结果本组104例患者均获随访,随访时间(18.41±7.39)个月,平均8～30个月;手术平均时间:单节段(51.30±2.17)min,双节段(105.53±7.14)min;平均出血量:单节段(43.72±2.63)mL,双节段(71.57±4.20)mL。神经根型颈椎病:末次随访时日本骨科协会(Japanese orthopaedic association,JOA)、视觉模拟评分(visual analogue scale,VAS)及椎间隙高度平均为(16.79±0.95)分、(2.36±0.90)分及(6.76±1.11)mm,与术前的(14.53±1.02)分、(7.70±1.60)分及(3.94±0.78)mm比较,差异有统计学意义(P<0.001);脊髓型颈椎病:末次随访时JOA、VAS评分及椎间隙高度平均为(14.21±1.82)分、(1.44±0.79)分及(6.50±1.13)mm,与术前的(10.18±1.62)分、(3.53±1.46)分及(3.71±0.80)mm比较,差异有统计学意义(P<0.001)。末次随访时104例均获骨性融合,平均融合时间:单节段(4.20±1.53)个月,双节段(5.41±6.15)个月。本组病例未出现喉返神经损伤、脑脊液漏、脊髓损伤、吞咽困难等并发症,随访期间均未发生感染、ROI-C松动移位或下沉等。结论退变性颈椎病行ACDF应用ROI-C能有效重建病变椎间隙高度,获得可靠的颈椎稳定性及椎间融合率,且手术时间短、术中出血少,术后并发症低,术后神经功能及疼痛改善显著,因此颈椎病行ACDF中单独应用ROI-C安全、有效,可获得满意的临床疗效。

Objective To evaluate the clinical efficacy of ROI-C in the treatment of degenerative cervical spondylosis with anterior cervical discectomy and fusion.Methods A retrospective analysis from October 2013 to September 2016,104 patients underwent degenerative cervical spondylosis anterior intervertebral decompression and ROI-C interbody fusion,with 108 ROI-C implanted.There were 40 cases of nerve root type cervical spondylosis and 64 cases of cervical spondylotic myelopathy.X-rays or CT were perfomed 3 days,3 months,6 months and 12 months after operation.Neural function and pain were evaluated at the end of the follow-up with the JOA and VAS score to observe the operation time,intraoperative blood loss and complications.Intervertebral height changes and intervertebral fusion were evaluated according to the final follow-up cervical X or CT.Results 104 cases were followed up for（18.41±7.39）months（ranging from 8 to 30 months）.The operation time was（51.30±2.17）min in single segment procedures and（105.53±7.14）min two segment procedures;the average operative bleeding was（43.72±2.63）mL in single segment procedures and（71.57±4.20）mL in two segment procedures.In nerve root type cervical spondylosis patients,JOA and VAS score,vertebral height improved significantly from preoperative（14.53±1.02）,（7.70±1.60）and（3.94±0.78）mm to postoperative（16.79±0.95）,（2.36±0.90）and（6.76±1.11）mm（P=0.001）at the end of follow-up.In cervical spondylotic myelopathy patients,JOA and VAS score,vertebral height improved significantly from preoperative（10.18±1.62）,（3.53±1.46）and（3.71±0.80）mm to postoperative（14.21±1.82）,（1.44±0.79）and（6.50±1.13）mm（P=0.001）：at the end of follow-up.The average time of fusison in single segment group was（4.20±1.53）months,（5.41±6.15）months in two segment group,and 7 months in 3 segment group.No complications were observed in all the cases such as spinal cord injury,dysphagia,hoarseness and ROI-C shifting or sinking.Conclusion In the treatment of degenerative cervical spondylosis,ACDF with ROI-C can effectively reconstruct the intervertebral height,obtaining reliable cervical intervertebral stability and fusion rate,as for shorter operative time,less bleeding,less postoperative complications and improving the neurological function and postoperative pain significantly,so ACDF using ROI-C alone in treatment of cervical spondylosis is safe,effective,and clinical effect satisfactory.