两种固定融合系统在颈椎前路椎间盘切除融合手术中的应用比较

Comparison of two fixation fusion systems in anterior cervical discectomy and fusion surgery

目的比较2种固定融合系统在颈椎前路椎间盘切除融合术(ACDF)中的疗效和安全性。方法回顾性分析2017年3月至2019年3月首都医科大学附属北京友谊医院收治的58例行ACDF手术患者临床资料,根据手术方式不同分为2组,手术分别应用钛制钢板联合cage融合器(PG组)31例(35融合节段),零切迹Zero-P固定融合装置(ZP组)27例(33融合节段)。记录2组患者手术时间、出血量,并比较术后主要并发症、疼痛视觉模拟量表(VAS)评分、日本骨科学会脊髓神经功能评分(JOA)评分及影像学资料情况。结果58例患者随访12个月以上。ZP组手术时间为(99.4±20.6)min,少于PG组[(111.9±19.7)min],差异有统计学意义(P<0.05)。ZP组出血量为(35.9±14.2)mL,显著少于PG组[(51.0±26.6)mL],差异有统计学意义(P<0.05)。2组患者术后2周内吞咽困难症状的发生率比较(3.7%vs.12.9%),差异均无统计学意义(P>0.05)。ZP组术后2周内食管异物感发生率显著低于PG组(7.4%vs.29.0%),差异有统计学意义(P<0.05)。2组患者内植物移位松动(0 vs.3.2%)、术后6个月内椎间不融合(3.7%vs.6.5%)发生率比较,差异均无统计学意义(P>0.05)。术后12个月2组患者VAS评分[(1.7±1.1)分vs.(1.6±1.1)分]、JOA评分[(15.7±0.9)分vs.(15.4±1.1)分]、神经功能恢复率[(83.4±12.9)%vs.(79.4±15.2)%]、生理曲度Cobb角[(14.6±3.8)°vs.(13.7±3.4)°]和手术椎间隙后缘高度[(8.0±1.5)mm vs.(7.5±1.7)mm]比较,差异均无统计学意义(P>0.05)。结论在ACDF手术中,应用钛制钢板联合cage融合器和零切迹Zero-P固定融合装置均是安全有效的。应用Zero-P装置手术更快捷,出血更少,明显减少术后食管异物感的发生率,值得临床推广。

Objective The study aimed to investigate and compare the efficiency and safety of two fixation fusion systems in anterior cervical discectomy and fusion(ACDF)surgery.Methods Retrospective analysis of Clinical data of 58 patients undergoing ACDF surgery admitted to Beijing Friendship Hospital,Capital Medical University,from March 2017 to March 2019 were retrospectively analyzed.Titanium steel plate combined with cage fusion device(plate group,PG 31 cases,35 fusion segments)and Zero-P fixation fusion device(Zero-P group,ZP 27 cases,33 fusion segments)was applicated in different operations.The operation time,blood loss,main complications,postoperative pain(VAS)score,neurological function(JOA)score,radiological data were observed and compared statistically.Results Fifty eight patients were followed up for more than 12 months.The operation time of ZP group was(99.4±20.6)min,which was shorter than that of PG group[(111.9±19.7)min],the difference was statistically significant(P<0.05).The blood loss of(35.9±14.2)mL in the ZP group was significantly less than that in the PG group[(51.0±26.6)mL],and the difference was statistically significant(P<0.05).There was no significant difference in the incidence of dysphagia symptoms in the two groups within 2 weeks after surgery(3.7%vs.12.9%)(P>0.05).The incidence of foreign body sensation in the esophagus within 2 weeks after operation in the ZP group was significantly lower than that in the PG group(7.4%vs.29.0%),and the difference was statistically significant(P<0.05).There was no statistically significant difference in the incidence of implant loosening(0 vs.3.2%)and interbody non-union within 6 months after operation(3.7%vs.6.5%)in the two groups(P>0.05).VAS score[(1.7±1.1)points vs.(1.6±1.1)points],JOA score[(15.7±0.9)points vs.(15.4±1.1)points],nerve function Recovery rate[(83.4±12.9)%vs.(79.4±15.2)%],Cobb angle of physiological curvature[(14.6±3.8)°vs.(13.7±3.4)°]and height of the posterior edge of the surgical intervertebral space[(8.0±1.5)mm vs.(7.5±1.7)mm]at 12 month follow-up in the two groups,the differences were not statistically significant(P>0.05).Conclusion During the ACDF operations,it was efficiency and safety with titanium steel plate combined with cage and Zero-P fixation fusion systems.The application of Zero-P device can make the operations more quicker,it could significantly reduce blood loss and the incidence of esophagus foreign body sensation within 2 weeks after the operation.The Zero-P device was worthy of clinical promotion.