颈前路ROI-C置入术与传统术式治疗颈椎间盘突出症对JOA评分及Cobb角的影响

Comparison of effects of anterior cervical approach ROI-C placement and traditional surgical method on JOA score and Cobb angle in cervical disc herniation

目的比较颈前路桥形锁定融合器(ROI-C)置入术与传统术式治疗颈椎间盘突出症(CDH)对JOA评分、Cobb角的影响。方法回顾性分析北京中医药大学东方医院2016年6月~2017年6月94例行颈前路治疗的CDH患者临床资料,按治疗方式分为ROI-C组(n=41)与传统组(n=53)。比较两组患者手术情况相关指标、颈部功能障碍指数(NDI)评分、日本骨科协会(JOA)评分及颈椎生理曲度(Cobb角)情况;统计植骨融合率及手术并发症,并与末次随访结果进行比较。结果ROI-C组手术耗时明显短于传统组(P<0.05),而术中出血量、术口长度与传统组比较,差异无统计学意义(P>0.05);两组患者术后1、3个月以及末次随访时NDI评分、JOA评分、Cobb角明显优于术前(均P<0.05),ROI-C组与传统组NDI评分、JOA评分、Cobb角比较,差异无统计学意义(P>0.05);两组患者术后植骨融合率比较,差异无统计学意义(P>0.05),而ROI-C组吞咽困难、相邻节段退变并发症发生率明显低于传统组(P<0.05)。结论颈前路ROI-C置入术与传统术式均可有效治疗CDH,两者在临床疗效、颈椎生理曲度及植骨融合率等方面无明显差异,但ROI-C置入术手术时间短,吞咽困难、相邻节段退变并发症发生率低。

Objective To compare the effects of anterior cervical interbody fusion cage(ROI-C)placement and traditional surgical method on JOA score and Cobb angle in cervical disc herniation(CDH).Methods A retrospective analysis was performed on 94 patients with CDH who underwent anterior cervical approach treatment from June 2016 to June 2017 in Oriental Hospital of Beijing University of traditional Chinese medicine,including 41 patients in ROI-C group and 53 patients in traditional group.The surgery related indexes,neck dysfunction index(NDI)score,Japanese Orthopaedic Association(JOA)score and cervical curvature(Cobb angle)were compared between the two groups,and the bone graft fusion rate and surgical complications were counted and compared with the last follow-up results.Results The surgery time in ROI-C group was significantly shorter than that in traditional group(P<0.05),and there were no significant differences in the intraoperative blood loss and surgical incision length compared with those in traditional group(P>0.05).The NDI score,JOA score and Cobb angle at 1 month after surgery,at 3 months after surgery and at the last follow-up were significantly better than those before surgery(P<0.05),and there were no significant differences in the NDI score,JOA score and Cobb angle between ROI-C group and traditional group(P>0.05).There was no significant difference in the postoperative bone graft fusion rate between the two groups(P>0.05).The incidence rates of dysphagia and adjacent segment degeneration in ROI-C group were significantly lower than those in traditional group(P<0.05).Conclusion Anterior cervical approach ROI-C placement and traditional surgical method both can effectively treat CDH.There are no significant differences in the clinical efficacy,cervical curvature and bone graft fusion rate,but ROI-C placement has shorter surgery time,and lower incidence rates of complications of dysphagia and adjacent segment degeneration.