自锁定式零切迹椎间融合器与前路接骨板治疗无骨折脱位型颈髓损伤疗效比较

Outcome comparison of ROI-C and PCP in ACDF for cervical spinal cord injury without fracture or dislocation

背景:随着自锁定式零切迹椎间融合器(ROI-C)在颈椎前路手术中的广泛应用,ROI-C也被应用于无骨折脱位型颈髓损伤患者的手术治疗。目的:比较ROI-C及传统前路接骨板cage系统治疗无骨折脱位型颈髓损伤患者的疗效。方法:回顾性分析2012年9月至2018年12月收治的42例接受颈椎前路手术治疗的无骨折脱位型颈髓损伤患者。其中23例采用ROI-C(ROI-C组),19例采用传统前路接骨板cage系统(接骨板固定组)。记录两组患者手术时间、术中失血量及术后并发症,手术前后神经功能[包括日本骨科协会评分(JOA)、颈部功能障碍指数(NDI)]以及影像学指标(包括颈椎融合率、颈椎生理曲度、手术节段椎间盘高度),并进行比较。结果:所有患者均顺利完成手术,术后无严重并发症。与接骨板固定组患者比较,ROI-C组患者平均手术时间更短,失血量更少,且差异均有统计学意义(P均<0.05)。两组患者术后各出现2例轻度吞咽困难。两组患者术后吞咽困难发生率差异无统计学差异。术后两组患者JOA评分、NDI均较术前改善,颈椎生理弧度、椎间隙高度均较术前增加,差异均有统计学意义(P均<0.05或0.01),且均获得满意椎间融合。各随访时间点两组患者JOA评分、NDI、颈椎生理弧度差异均无统计学意义。出院前即术后首次影像学检查结果显示,ROI-C组患者椎间隙高度大于接骨板固定组患者,且差异有统计学意义(P<0.05);而术后3个月ROI-C组患者椎间隙高度下降多于接骨板固定组患者,且差异有统计学意义(P<0.05)。结论:颈椎前路手术能有效改善无骨折脱位型颈髓损伤患者的神经功能,恢复颈椎生理曲度和椎间隙高度。相比传统接骨板,ROI-C手术时间少,创伤小,且术后短期颈椎生理曲度和椎间隙高度恢复更为显著,但仍需注意颈托固定,防止早期椎间隙高度丢失。

Background:With the gradual popularity of the zero-profile anchored spacer(ROI-C)in anterior cervical discectomy and fusion(ACDF),ROI-C is applied in the treatment of mild cervical spinal cord injury without fracture or dislocation.Objective:To compare efficacy between ROI-C and conventional cage-plate construct(CPC)in ACDF for cervical spinal cord injury without fracture or dislocation.Methods:Clinical and radiological outcomes of 42 patients who had cervical spinal cord injury without fracture or dislocation and underwent ACDF from September 2012 to December 2018,were retrospectively reviewed.ROI-C was used in 23 patients and CPC was used in 19 patients.Operation time,intraoperative blood loss,complications,neurological function(Japanese Orthopaedic Association[JOA]score and Neck Disability Index[NDI])were evaluated for clinical outcomes.Radiological outcomes,such as cervical curvature,fusion rate,and intervertebral space height of the surgical segment were measured as well.Results:All patients had a successful ACDF surgery without severe complications.Compared with the CPC group,ROI-C group had shorter operation time and less bleeding volume(P<0.05).Two cases showed mild dysphagia in each group,but no statistical difference was found in the incidence of dysphagia between the two groups.In both groups,the JOA score and NDI were significantly improved after surgery,as well as cervical curvature and intervertebral space height.(P<0.05 or 0.01).Besides,patients all achieved satisfactory interbody fusion rate.There was no significant difference in JOA,NDI,or cervical curvature at any follow-up time point between groups.The first postoperative radiological examination showed that the intervertebral space height in the ROI-C group were significantly larger than that in the CPC group(P<0.05),whereas it dropped more in the ROI-C group as compared to the CPC group 3 months postoperatively(P<0.05).Conclusions:ACDF with both ROI-C and CPC can effectively treat cervical spinal cord injury without fracture or dislocation,and recover the nerve function,cervical curvature and intervertebral space height.Compared with CPC,there are less trauma,shorter operation time,better postoperative recovery of curvature and intervertebral height in ACDF with ROI-C.Moreover,it is still important to wear cervical collar for prevention of the loss of intervertebral height within first 3 months after surgery.