颈前路零切迹椎间融合固定双节段颈椎病

Zero-profile interbody device versus cage-plate system in anterior cervical discectomy and fusion for double-segment cervical spondylosis

[目的]比较颈前路零切迹椎间融合(Zero-P)固定系统与常规笼架-钢板系统用于前路颈椎间切除融合术治疗双节段颈椎病的临床效果。[方法]回顾性分析2016年5月~2019年3月手术治疗的双节段颈椎病患者120例,其中,62例采用零切迹固定系统,58例采用常规笼架-钢板系统。比较两组患者围手术期、随访和影像资料。[结果]Zero-P组手术时间、术中出血量、住院时间和术后早期并发症均显著优于笼架钢板组(P<0.05)。所有患者均获12个月以上随访,Zero-P组术后恢复颈椎完全负重活动时间显著早于笼架钢板组(P<0.05)。与术前相比,末次随访时两组患者VAS评分显著下降(P<0.05),而JOA评分和SF-36评分显著增加(P<0.05);术前两组间VAS、JOA和SF-36评分的差异均无统计学意义(P>0.05),末次随访时Zero-P组VAS、JOA和SF-36评分均显著优于笼架钢板组(P<0.05)。影像方面,术前两组间颈椎前凸Cobb角和椎间隙高度差异均无统计学意义(P>0.05),而末次随访时,Zero-P组的上述参数的改善显著优于笼架钢板组(P<0.05);此外,Zero-P组骨性融合时间显著早于笼架钢板组(P<0.05)。[结论]对于双节段颈椎病,颈前路零切迹椎间融合器明显优于常规钢板椎间融合器。

[Objective] To compare the clinical outcomes of zero-profile interbody device(Zero-P) versus cage-plate system(CP) in anterior cervical discectomy and fusion(ACDF) for double-segment cervical spondylosis. [Methods] A retrospective study was conducted on 120 patients who underwent surgical treatment for double-segment cervical spondylosis in our hospital from May 2016 to March 2019.Of them, 62 patients had ACDF performed with the Zero-P, while the remaining 58 patients had operation conducted with CP. The two groups were compared regarding to perioperative, follow-up and radiographic documents. [Results] The Zero-P group proved significantly superior to the CP group in operation time, intraoperative blood loss, hospital stay and early complications after operation(P<0.05). All the patients were followed up for more than 12 months. The Zero-P group returned to full-weight bearing activity significantly earlier than the CP group(P<0.05). The VAS score significantly decreased, whereas the JOA and SF-36 scores significantly increased at the latest followup compared with those before operation in both groups(P<0.05). The Zero-P group was significantly superior to the CP group in VAS,JOA and SF-36 scores at the latest follow-up(P<0.05), nevertheless no statistically significant differences were noted in aforesaid scores before operation(P>0.05). Regarding radiographic assessment, the cervical lordotic Cobb.s angle and intervertebral disc height significantly increased at the latest follow-up in both group compared with those before operation(P<0.05), which in the Zero-P group were significantly superior to the CP group at the latest follow-up(P<0.05) despite of no statistical differences between the two groups before operation(P>0.05). In addition, the Zero-P group achieved bony fusion significantly earlier than the CP group(P<0.05). [Conclusion] The zero-profile interbody device does achieve improved clinical outcomes for double-segment cervical spondylosis over the conventional cage-plate system.