摘要
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.
作者
杨俊松
刘鹏
刘团江
刘继军
陈浩
许晓舟
张嘉男
张正平
郝定均
YANG Junsong;LIU Peng;LIU Tuanjiang;LIU Jijun;CHEN Hao;XU Xiaozhou;ZHANG Jianan;ZHANG Zhengping;HAO Dingjun(Department of Spine Surgery,Honghui Hospital Affiliated to Medical School of Xi'an Jiaotong University,Xi'an Shaanxi,710054,P.R.China)
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2020年第2期151-156,共6页
Chinese Journal of Reparative and Reconstructive Surgery
基金
国家自然科学基金重点项目(81830077)~~
关键词
单节段颈椎病
颈前路椎间盘切除减压融合术
零切迹椎间融合器
钛板-椎间融合器
颈椎曲度
Single-segment cervical spondylosis
anterior cervical discectomy and fusion
zero-profile and self-locking intervertebral cage
plate-cage construct
cervical curvature