零切迹椎间融合器与钛板-椎间融合器系统对颈前路术后颈椎曲度维持的临床研究

Effect of zero-profile and self-locking intervertebral cage and plate-cage construct on maintenance of cervical curvature after anterior cervical surgery

目的探讨零切迹椎间融合器与钛板-椎间融合器(plate-cage construct,PCC)系统在颈椎前路术后颈椎曲度维持方面的差异。方法回顾分析2015年1月—2016年1月收治并行颈前路椎间盘切除减压融合术治疗的100例单节段颈椎间盘突出症患者临床资料,其中50例采用零切迹椎间融合器(A组),50例采用PCC系统(B组)。两组患者性别、年龄、骨密度、病变节段、病程及术前疼痛视觉模拟评分(VAS)、日本骨科协会(JOA)评分、C2~7颈椎曲度、节段Cobb角、相邻椎体高度等一般资料比较,差异均无统计学意义(P>0.05),具有可比性。记录两组手术时间及术中出血量;采用VAS评分和JOA评分评估临床疗效;于侧位X线片测量C2~7颈椎曲度、节段Cobb角和相邻椎体高度,根据Pitzen等椎间融合标准评估椎间融合情况。结果A组手术时间显著短于B组(t=2.442,P=0.021),但两组术中出血量差异无统计学意义(t=0.812,P=0.403)。两组患者均获随访,随访时间24~36个月,平均28.5个月。根据Pitzen等的椎间融合标准,两组均达骨性融合。两组内术后1、24个月VAS评分、JOA评分及C2~7颈椎曲度、节段Cobb角、相邻椎体高度均较术前显著改善(P<0.05);除A组术后24个月C2~7颈椎曲度、节段Cobb角及相邻椎体高度较术后1个月有明显丢失(P<0.05)外,两组其余疗效评价指标术后两时间点间差异均无统计学意义(P>0.05)。两组术后24个月C2~7颈椎曲度、节段Cobb角、相邻椎体高度差异有统计学意义(P<0.05),其余各时间点疗效评价指标差异均无统计学意义(P>0.05)。结论颈前路术中采用零切迹椎间融合器虽能获得与PCC系统相似疗效、缩短手术时间,但术后椎间隙高度丢失以及继发颈椎曲度改变均大于PCC系统。

Objective To compare differences in the maintenance of cervical curvature after anterior cervical surgery between zero-profile and self-locking intervertebral cage and plate-cage construct(PCC).Methods A clinical data of 100 patients with single-segment cervical disc herniation who were treated with anterior cervical discectomy and fusion were retrospectively analyzed between January 2015 and January 2016.Among them,50 patients were treated with the zero-profile and self-locking intervertebral cage(group A)and 50 patients with the PCC(group B).There was no significant difference between the two groups in age,gender,bone mineral density,disease duration,operative segment,and preoperative visual analogue scale(VAS)score,Japanese Orthopaedic Association(JOA)score,C2-7 cervical curvature,segmental Cobb angle,and adjacent vertebral height(P>0.05).The operation time and intraoperative blood loss were recorded.The postoperative VAS and JOA scores were used to evaluate the clinical efficacy.The C2-7 cervical curvature,segmental Cobb angle,and adjacent vertebral height were measured on lateral X-ray films,and the interbody fusion was evaluated according to Pitzen’s criteria.Results The operation time in group A was significantly shorter than that in group B(t=2.442,P=0.021),but there was no significant difference in the intraoperative blood loss between the two groups(t=0.812,P=0.403).All patients were followed up 24-36 months,with an average of 28.5 months.According to Pitzen’s criteria for cervical interbody fusion,bone fusion achieved in both groups.The VAS score,JOA score,C2-7 cervical curvature,segmental Cobb angle,and adjacent vertebral height of the two groups at 1 and 24 months after operation were significantly improved when compared with those before operation(P<0.05).The C2-7 cervical curvature,segmental Cobb angle,and adjacent vertebral height of group A at 24 months changed significantly compared with those at 1 month(P<0.05).The other indexes of the two groups showed no significant difference between the different time points after operation(P>0.05).There were significant differences in C2-7 cervical curvature,segmental Cobb angle,and adjacent vertebral height between the two groups at 24 months after operation(P<0.05);but there was no significant difference in the clinical indexes at 1 and 24 months and the imaging indexes at 1 month between the two groups(P>0.05).Conclusion Compared with the PCC,the zero-profile and self-locking intervertebral cage can significantly shorten the operation time and obtain the same clinical efficacy,but the intervertebral height loss and secondary cervical curvature change after operation is more serious.