可变角度零切迹前路椎间融合内固定系统治疗脊髓型颈椎病:30个月随访

Variable-angle zero-notch anterior interbody fusion system in the treatment of cervical spondylotic myelopathy:30-month follow-up

背景:目前颈椎前路椎间盘切除融合是手术治疗颈椎病的“金标准”,其中颈前路零切迹椎间融合器逐渐在临床中推广并应用,具有良好的临床疗效及影像学结果。目的:评价可变角度零切迹前路椎间融合内固定系统在颈椎前路手术中治疗脊髓型颈椎病的中期疗效。方法:纳入2015年1月至2018年1月广州中医药大学第一附属医院收治的脊髓型颈椎病患者81例,其中42例采用可变角度零切迹前路椎间融合内固定系统行颈椎前路椎间盘切除减压融合治疗(试验组),39例采用传统钛板-cage系统行颈椎前路椎间盘切除减压融合治疗(对照组)。随访比较两组患者的目测类比评分、日本骨科协会(JOA)评分、颈椎Cobb-C角、颈椎Cobb-S角、椎间融合情况及并发症发生情况。试验方案已获得广州中医药大学第一附属医院伦理委员会批准(批件号:NO.JY2020199)。结果与结论:①两组患者术后的目测类比评分、JOA评分均较术前明显改善(P<0.05),两组间术后的目测类比评分与JOA评分比较差异均无显著性意义(P>0.05);②两组术后3 d、30个月时的Cobb-S角较术前均有明显改善(P<0.05),试验组术后3 d的Cobb-C角较术前明显改善(P<0.05),对照组术后3 d、30个月的Cobb-C角较术前明显改善(P<0.05);③试验组椎间完全融合率为98%,对照组椎间完全融合率为100%;④试验组融合器下沉率高于对照组(24%,3%,P<0.05),术后吞咽困难发生率低于对照组(2%,38%,P<0.05),相邻椎间盘退变发生率低于对照组(2%,18%,P<0.05);⑤结果表明,可变角度零切迹前路椎间融合内固定系统治疗脊髓型颈椎病可有效改善症状、减少术后并发症,但融合器下沉发生率较高,颈椎整体曲度的改变需更长期的观察与随访,该术式中期疗效总体良好。

BACKGROUND:At present,anterior cervical discectomy and fusion is the“gold standard”for treatment of cervical spondylosis.The cervical zero-notch anterior interbody fusion cage is gradually being promoted and applied in clinical practice,with good clinical efficacy and imaging results.OBJECTIVE:To evaluate the mid-term outcome of cervical spondylotic myelopathy treated with variable-angle zero-notch anterior interbody fusion system.METHODS:Totally 81 patients with cervical spondylotic myelopathy treated in First Affiliated Hospital of Guangzhou University of Chinese Medicine from January 2015 to January 2018 were included in this study.Among them,42 patients received anterior cervical discectomy and decompression and fusion using variable-angle zero-notch anterior interbody fusion system(trial group);39 patients received anterior cervical discectomy and decompression and fusion using traditional titanium plate-cage system(control group).Visual Analog Scale score,Japanese Orthopaedic Association score,Cobb-C angle and Cobb-S angle of cervical spine,interbody fusion,and complications were compared between the two groups.The protocols were approved by the Ethics Committee of First Affiliated Hospital of Guangzhou University of Chinese Medicine(approval No.JY2020199).RESULTS AND CONCLUSION:(1)Visual Analog Scale score and Japanese Orthopaedic Association score were significantly improved after surgery compared with those before surgery in both groups(P<0.05).No significant differences in Visual Analog Scale score and Japanese Orthopaedic Association score were detected between the two groups(P>0.05).(2)Cobb-S angle was significantly improved at 3 days and 30 months after surgery compared with that before surgery in both groups(P<0.05).Cobb-C angle was significantly improved at 3 days after surgery compared with that before surgery in the trial group(P<0.05).Cobb-C angle was significantly improved at 3 days and 30 months after surgery compared with that before surgery in the control group(P<0.05).(3)The rate of complete fusion was 98%in the trial group and 100%in the control group.(4)The rate of the fusion cage sinking in the trial group was higher than that in the control group(24%,3%,P<0.05);the incidence of postoperative dysphagia was lower than that in the control group(2%,38%,P<0.05);and the incidence of adjacent intervertebral disc degeneration was lower than that in the control group(2%,18%,P<0.05).(5)The results have shown that variable-angle zero-notch anterior interbody fusion system for cervical spondylotic myelopathy can effectively improve the symptoms and reduce postoperative complications.However,the incidence of fusion cage sinking was higher than that of traditional titanium plate-cage system.The change of the overall curvature of the cervical spine needs long-term observation and follow-up.The mid-term efficacy of the operation is generally good.