单节段颈椎病前路减压椎间植骨融合术后聚醚醚酮融合器沉降相关因素研究

Correlative factors for subsidence after anterior cervical discectomy and fusion with a polyetheretherketone cage for the single-level cervical spondylosis

背景:颈椎前路减压椎间植骨融合术(ACDF)在临床上广泛应用,其中聚醚醚酮融合器较为常用,术后融合器"沉降"问题也受到了国内外学者的关注。目的:回顾性分析应用聚醚醚酮融合器行植骨融合在治疗单节段颈椎间盘退行性疾病中的疗效,探讨术后融合器"沉降"的发生率,提供融合器"沉降"的测量方法并分析其相关的危险因素。方法:选取2011年9月至2015年2月单节段颈椎病患者39例,均采用颈前路减压、聚醚醚酮融合器植骨融合术,术后所有患者随访12~24个月,平均(15.3±2.5)个月。根据术前、术后即刻及随访时患者的症状、生活状态及影像学表现,对其疗效及术后并发症进行统计与评估。结果:本研究39例患者平均手术时间为(55.0±5.6)min,术中出血量均<50ml。术后3个月随访时融合率为94.9%,术后6个月融合率达100%。无融合器松动、移位的现象,5例患者出现融合器"沉降",沉降发生率为12.8%,其中3例沉降范围为2~3 mm,2例>3 mm。根据VAS评分标准,术前、术后及末次随访时颈背痛及上肢疼痛,非沉降组分别为(7.5±1.3)分、(2.1±0.7)分、(2.1±0.6)分,沉降组分别为(7.4±1.1)分、(1.8±0.8)分、(2.2±0.8)分。两组同时期评分比较差异无统计学意义(P>0.05)。术后根据Robinson评价标准,优19例,良14例,一般5例,差1例,优良率为84.6%。结论:在单节段颈椎间盘退行性疾病的手术治疗中,颈前路减压应用聚醚醚酮融合器行植骨融合术出血量少、临床疗效好、植骨融合率高。但融合器"沉降"发生率较高,虽不影响中期疗效,但应加以关注。

Background: Anterior cervical discectomy and fusion (ACDF) with a polyetheretherketone (PEEK) cage (ACDF+ cage) has been widely applied and recognized. However, more and more cage subsidences have attracted the attention of schol-ars both at home and abroad. Objective: To retrospectively analyze the clinical effect of ACDF with a PEEK cage on one-level cervical disc degeneration, explore the incidence of cage subsidence, propose the measuring method for cage subsidence and analyze the related risk factors. Methods: Form September 2011 to February 2015, 39 patients with one-level cervical disc de-generation underwent ACDF with PEEK cages. All patients had at least 12 months of follow-up with an average of (15.3±2.5) months (range 12-24 months). The effectiveness and postoperative complications were evaluated according to symptom, life state and imaging findings of the patients in preoperative, postoperative and follow-up periods respectively. Results: The mean surgical time was (55.0±5.6) min, and all patients had their blood loss less than 50 ml. The fusion rate was 94.9% at three months after operation, while at six months after operation the rate reached 100%. None of patients had cage loose or shift. Five patients were found cage subsidence including 3 patients subsidence range of 2-3 mm and 2 patients >3 mm with the i-ncidence of 12.8%. The VAS scores of the arm and neck pain were (7.5±1.3),(2.1±0.7) and (2.1±0.6) in preoperative, postoper-ative immediately and final follow-up periods in the non-subsidence group and (7.4±1.1),(1.8±0.8) and (2.2±0.8) in the sub-sidence group. There was no significant difference in VAS score of those three periods between the two groups (P >0.05). A-ccording to Robinson's criteria, 19 patients were scored excellent, 14 patients good, 5 patients general, 1 patient bad, and the incidence of excellent and good was 84.6%. Conclusions: ACDF with a PEEK cage is a viable method for one-level cervical disc degeneration, which has the advantages of less blood loss, good clinical effect and a high incidence of bone fusion, howev-er, there is a high incidence of cage subsidence, and attention should be paid, although it has no significant influence on medi-um-term clinical effect.