颈椎前路单节段cage与zero-P辅助减压融合术治疗颈椎退变性疾病的疗效比较

Comparison of clinical effects between single-segment stand-alone polyetheretherketone cage and zero-profile anchored spacer assisted anterior decompression and fusion for cervical degenerative diseases

背景:颈椎前路减压融合术已广泛应用于临床上治疗颈椎退变性疾病。目的:比较颈椎前路单节段cage及zero-P辅助减压融合术治疗颈椎退变性疾病的临床疗效。方法:回顾性分析44例颈椎退变性疾病并接受颈椎前路减压单节段椎间融合器植骨融合术患者,其中23例应用cage椎间融合器,21例应用zero-P椎间融合器。记录两组患者术前、术后1、6个月颈椎功能障碍指数(NDI)评分、颈脊髓功能日本骨科学会评分(JOA)、颈椎曲度D值、前柱高度,并进行比较。观察椎间植骨融合及椎间融合器沉降情况。结果:两组患者术后1、6个月NDI评分均低于术前,JOA评分均高于术前,且差异均有统计学意义(P均<0.05),而术后1个月与术后6个月NDI评分、JOA评分差异均无统计学意义。两组患者术后1、6个月颈椎曲度D值均较术前增加,且差异均有统计学意义(P均<0.05)。Zero-P组患者术后1、6个月颈椎前柱高度均较术前增加,且差异均有统计学意义(P均<0.05);而术后1个月与术后6个月颈椎曲度D值差异无统计学意义。而cage组患者术前、术后1、6个月颈椎前柱高度差异无统计学意义。术后6个月两组患者手术节段均完全融合。Zero-P组有1例患者发生内固定物沉降。结论:单纯cage或zero-P椎间融合器辅助的颈椎前路减压融合术是治疗单节段颈椎退变性疾病安全有效的手术方法。

Background: Anterior cervical decompression and fusion(ACDF) has been widely used in the treatment of cervical degenerative diseases. Objective: To compare the clinical effects of single-segment ACDF with stand-alone polyetheretherketone cage and zero-profile anchored spacer(zero-P) on cervical degenerative diseases. Methods: We retrospectively analyzed clinical data of 44 patients with cervical degenerative diseases who underwent single-segment ACDF. Of them, 23 patients were allocated to the cage group and 21 patients to the zero-P group. Clinical results assessed by NDI and JOA scores and radiological results including cervical spine curvature, anterior column height of fusion segments were recorded and compared between two groups before operation, 1 month and 6 months after operation. The fusion rate and incidence of cage subsidence were also evaluated. Results: The NDI scores at 1 month and 6 months after operation in both groups were significantly lower than preoperative ones, while postoperative JOA scores were significantly higher than preoperative ones(P<0.05). There were no significant differences in the NDI or JOA score between 1 month and 6 months after operation. Cervical spine curvature at 1 month and 6 months after operation was significantly larger than preoperative ones in both groups(P<0.05). In the zero-P group, the anterior column height was significantly increased at 1 month and 6 months after operation as compared with preoperative one(P<0.05), whereas there was no significant difference in the cervical spine curvature between 1 month and 6 months after operation. No significant difference was found in the anterior column height in the cage group at any time point.The fusion rate was 100% in two groups and only one cage subsidence was found in the zero-P group. Conclusions: ACDF assisted by both cage and zero-P is safe and effective for single-segment cervical degenerative disease.