Prodisc-C Vivo人工椎间盘置换术与零切迹Zero-P融合术治疗单节段颈椎病早期疗效比较

Comparison of short-term effectiveness of Prodisc-C Vivo artificial disc replacement and Zero-P fusion for treatment of single-segment cervical spondylosis

目的比较研究Prodisc-C Vivo人工椎间盘置换术与零切迹Zero-P融合术治疗单节段颈椎病的早期疗效及其对颈椎节段活动度的影响。方法回顾分析2015年1月—2018年12月收治且符合选择标准的56例单节段颈椎病患者临床资料,根据手术方式分为研究组(27例,采用Prodisc-C Vivo人工椎间盘置换术)和对照组(29例,采用零切迹Zero-P融合术)。两组患者性别、年龄、颈椎病类型、病程、累及节段及术前疼痛视觉模拟评分(VAS)、日本骨科协会(JOA)评分、颈椎功能障碍指数(NDI)、手术节段活动度、上下相邻节段活动度、颈椎整体活动度及颈椎曲度等一般指标比较,差异均无统计学意义(P>0.05)。记录并比较两组手术时间、术中出血量、术后住院时间、术后恢复工作时间及临床疗效指标(VAS评分、JOA评分、NDI及各评分改善率)和影像学指标(手术节段活动度、上下相邻节段活动度、颈椎整体活动度、颈椎曲度及假体位置、骨质吸收、异位骨化等)。结果两组手术时间和术中出血量比较差异无统计学意义(P>0.05);研究组术后住院时间和术后恢复工作时间明显少于对照组(P<0.05)。两组患者均获随访,随访时间12~64个月,平均26个月。均未出现肢体脏器功能损害、内植物失败及相邻节段退变严重需再次手术等并发症。术后各时间点两组VAS评分、JOA评分及NDI均较术前显著改善(P<0.05),术后各时间点两组间各评分比较差异均无统计学意义(P>0.05);末次随访时两组间各评分改善率比较差异均无统计学意义(P>0.05)。研究组术后不同程度维持了手术节段活动度,对照组术后手术节段活动度基本消失,两组比较差异有统计学意义(P<0.05)。末次随访时,研究组上、下相邻节段活动度与术前比较差异无统计学意义(P>0.05),而对照组上位相邻节段活动度较术前明显增加(P<0.05);两组颈椎整体活动度及颈椎曲度在术后3个月有所下降,末次随访时又有不同程度增加,组间及组内比较差异均无统计学意义(P>0.05)。末次随访时X线片及CT检查示,所有患者未见假体松动、下沉或移位等;研究组发生人工椎间盘下椎体终板前缘部分骨质吸收2例(7.4%),未影响手术节段活动度的异位骨化3例(11.1%)。结论Prodisc-C Vivo人工椎间盘置换术与零切迹Zero-P融合术治疗单节段颈椎病早期疗效均满意,前者还能在一定程度上维持颈椎手术节段活动度,同时减少术后相邻节段代偿性过度活动的发生。

Objective To compare the short-term effectiveness and the impact on cervical segmental range of motion using Prodisc-C Vivo artificial disc replacement and Zero-P fusion for the treatment of single-segment cervical spondylosis.Methods The clinical data of 56 patients with single-segment cervical spondylosis who met the selection criteria between January 2015 and December 2018 were retrospectively analyzed,and they were divided into study group(27 cases,using Prodisc-C Vivo artificial disc replacement)and control group(29 cases,using Zero-P fusion)according to different surgical methods.There was no significant difference between the two groups in terms of gender,age,type of cervical spondylosis,disease duration,involved segments and preoperative pain visual analogue scale(VAS)score,Japanese Orthopaedic Association(JOA)score,neck disability index(NDI),surgical segments range of motion,upper and lower adjacent segments range of motion,overall cervical spine range of motion,and cervical curvature(P>0.05).The operation time,intraoperative blood loss,postoperative hospitalization stay,time of returning to work,clinical effectiveness indicators(VAS score,JOA score,NDI,and improvement rate of each score),and imaging indicators(surgical segments range of motion,upper and lower adjacent segments range of motion,overall cervical spine range of motion,and cervical curvature,prosthesis position,bone absorption,heterotopic ossification,etc.)were recorded and compared between the two groups.Results There was no significant difference in operation time and intraoperative blood loss between the two groups(P>0.05);the postoperative hospitalization stay and time of returning to work in the study group were significantly shorter than those in the control group(P<0.05).Both groups were followed up 12-64months,with an average of 26 months.There was no complication such as limb or organ damage,implant failure,and severe degeneration of adjacent segments requiring reoperation.The VAS score,JOA score,and NDI of the two groups at each time point after operation significantly improved when compared with those before operation(P<0.05);there was no significant difference in the above scores at each time point after operation between the two groups(P>0.05);there was no significant difference in the improvement rate of each score between the two groups at last follow-up(P>0.05).The surgical segments range of motion in the study group maintained to varying degrees after operation,while it in the control group basically disappeared after operation,showing significant differences between the two groups(P<0.05).At last follow-up,there was no significant difference in the upper and lower adjacent segments range of motion in the study group when compared with preoperative ones(P>0.05),while the upper adjacent segments range of motion in the control group increased significantly(P<0.05).The overall cervical spine range of motion and cervical curvature of the two groups decreased at 3 months after operation,and increased to varying degrees at last follow-up,but there was no significant difference between groups and within groups(P>0.05).At last follow-up,X-ray films and CT examinations showed that no prosthesis loosening,subsidence,or displacement was found in all patients;there were 2 cases(7.4%)of periprosthetic bone resorption and 3 cases(11.1%)of heterotopic ossification which did not affect the surgical segments range of motion.Conclusion Both the Prodisc-C Vivo artificial disc replacement and Zero-P fusion have satisfactory short-term effectiveness in treatment of single-segment cervical spondylosis.Prodisc-C Vivo artificial disc replacement can also maintain the cervical spine range of motion to a certain extent,while reducing the occurrence of excessive motion of adjacent segments after fusion.