前路颈椎零切迹椎间融合内固定器治疗颈椎病

Treatment of anterior cervical zero-profile interbody fusion and fixation device for cervical spondylosis

目的探讨前路颈椎零切迹椎间融合内固定器(Zero-P)治疗颈椎病的临床效果。方法对2014年3月至2016年8月广东省中西医结合医院采用前路颈椎减压+Zero-P椎间植骨融合内固定术治疗的48例颈椎病患者的临床资料进行回顾性分析。记录手术时间和术中出血量,采用疼痛视觉模拟量表(VAS)评分、日本骨科学会(JOA)评分评价手术疗效。结果患者均顺利完成手术,手术时间95~175 min,平均手术时间(122.5±27.5)min;术中出血量100~300 m L,平均术中出血量(180.8±78.8)m L。术后未发生感染、神经损伤、食道瘘、椎前血肿并发症;2例患者出现轻度吞咽不适,4周后症状缓解并逐渐消失。48例患者均获随访,随访时间4~36个月,平均随访时间18.5个月。患者临床症状均较术前有不同程度缓解。术后3、12个月VAS评分、JOA评分均较术前显著改善,差异有统计学意义(P<0.05)。末次随访时JOA评分优28例、良15例、中5例,优良率90%。随访期间无内固定物移位下沉、螺钉拔出断裂、颈椎不稳或邻近节段退变征象。结论前路颈椎零切迹椎间融合内固定器治疗颈椎病具有力学稳定性好、术后吞咽不适发生率低、疗效显著等优点。

Objective To explore the clinical outcome of zero-profile interbody fusion and fixation device(Zero-P)for cervical spondylosis.Methods Clinical data of 48 patients with cervical spondylosis who treated from March 2014 to August 2016 in Guangdong Integrative Medicine Hospital by anterior cervical discectomy and fusion(ACDF)with Zero-P,were retrospectively analyzed.The operation time and intraoperative estimate blood loss were recorded,pain visual analogue scale(VAS)score and Japanese Orthopaedic Association(JOA)score were used to evaluate the clinical efficacy.Results The operations were successful in all patients.The operation time was 95-175 min with the average of(122.5±27.5)min,and the intraoperative estimate blood loss was 100-300 mL with the average of(180.8±78.8)mL.There were no complications such as infection,neural injury,esophageal fistula or prevertebral hematoma after the surgery;Mild dysphagia occurred in 2 cases,and resolved in 4 weeks.All patients were followed up for an average of 18.5 months(range,4-36 months),and their clinical symptoms were relieved after the operation in different degree.At 3 and 12 months postoperatively,VAS score and JOA score increased significantly compared to preoperative ones(P<0.05).According to JOA scores,there were excellent in 28 cases,good in 15,and fair in 5 cases,with an excellent and good rate of 90%at the lastest follow-up.During the follow-up,no implant displacement or subsidence,screw pullout or breakage,cervical instability or adjacent segment degeneration were observed in these patients.Conclusion For cervical spondylosis,treatment of ACDF with Zero-P has the advantages of good mechanical stability,lower incidences of postoperative dysphagia,as well as remarkable clinical effects.