颈前路减压cage与zero-p椎间植骨融合内固定治疗单节段颈椎病的疗效比较

Effectiveness comparison between anterior cervical decompression separately combined with cage and zero-p interbody fusion internal fixation in the treatment of single-segment cervical spondylosis

目的比较颈前路减压cage与zero-p椎间植骨融合内固定治疗单节段颈椎病的临床疗效。方法回顾性分析自2015-03—2018-03诊治的120例单节段颈椎病,60例采用颈前路减压zero-p椎间植骨融合内固定治疗(zero-p组),60例采用颈前路减压cage椎间植骨融合内固定治疗(cage组)。比较2组手术时间、术中出血量、术后出现吞咽困难数,比较2组术后3个月及末次随访时上肢疼痛VAS评分、JOA评分、C_(2~7)颈椎曲度、病椎Cobb角、邻近椎体高度,比较2组末次随访时Eck植骨融合等级。结果2组均顺利完成手术并获得至少2年的随访。zero-p组手术时间较cage组短,术后出现吞咽困难数较cage组少,差异有统计学意义(P<0.05)。2组术中出血量比较差异无统计学意义(P>0.05)。术后3个月及末次随访时2组颈部及上肢疼痛VAS评分、JOA评分比较差异无统计学意义(P>0.05)。术后3个月2组C_(2~7)颈椎曲度、病椎Cobb角、邻近椎体高度比较差异无统计学意义(P>0.05);末次随访时zero-p组C_(2~7)颈椎曲度、病椎Cobb角、邻近椎体高度较cage组小,差异有统计学意义(P<0.05)。末次随访时2组Eck植骨融合等级比较差异无统计学意义(P>0.05)。结论颈前路减压cage与zero-p椎间植骨融合内固定治疗单节段颈椎病疗效相当,而颈前路减压zero-p椎间植骨融合内固定手术时间较短,术后吞咽困难的发生率较低,但维持椎间高度与颈椎曲度的效果较差。

Objective To compare the clinical efficacy of anterior cervical decompression combined with cage and zero-p respectively interbody fusion internal fixation in the treatment of single-segment cervical spondylosis.MethodsOne hundred and twenty cases of single-segment cervical spondylosis diagnosed and treated from March 2015 to March 2018 were retrospectively analyzed, 60 cases were treated with anterior cervical decompression and zero-p interbody fusion internal fixation(zero-p group), and 60 cases were treated with anterior cervical decompression and cage intervertebral bone graft fusion and internal fixation(cage group). The operation time, intraoperative blood loss, and the number of dysphagia after the operation were compared between the two groups. The upper limb pain VAS score, JOA score, C_(2-7) cervical spine curvature, and the Cobb angle of the injured vertebrae at 3 months postoperatively and at the last follow-up were compared. The height of adjacent vertebral bodies was compared with the grade of Eck bone graft fusion at the last follow-up of the two groups.ResultsBoth groups successfully completed the operation and obtained at least 2 years of follow-up. The operation time of the zero-p group was shorter than that of the cage group, and the number of dysphagia after surgery was less than that of the cage group. The difference was statistically significant(P<0.05). There was no significant difference in intraoperative blood loss between the two groups(P>0.05). There was no significant difference in the upper limb pain VAS score and JOA score between the two groups at 3 months after operation and at the last follow-up(P>0.05). There was no significant difference in C_(2-7) cervical spine curvature, injured vertebrae Cobb angle, and adjacent vertebral body height in the two groups at 3 months after surgery(P>0.05);at the last follow-up, C_(2-7) cervical spine curvature, the Cobb angle of the injured vertebrae and the height of adjacent vertebral bodies of the zero-p group were smaller than those in the cage group, and the difference was statistically significant(P<0.05). At the last follow-up, there was no significant difference in the grade of Eck bone graft fusion between the two groups(P>0.05).ConclusionAnterior cervical decompression combined with cage and zero-p respectively interbody fusion internal fixation have the same effect in the treatment of singlesegment cervical spondylosis. Anterior cervical decompression combined with zero-p respectively interbody fusion internal fixation takes less time and has a lower incidence of postoperative dysphagia, but it can’t effectively maintain the intervertebral height and cervical curvature after the operation.