颈椎间盘突出症不同手术方式疗效及对颈椎曲度、邻近节段退变、安全性影响

Effect of different surgical methods on cervical disc herniation and its influence on cervical curvature,adjacent segment degeneration and safety

目的观察颈椎间盘突出症(CDH)不同手术方式的疗效及对颈椎曲度、邻近节段退变、安全性的影响。方法选取2019年6月—2022年6月江苏省宿迁市钟吾医院脊柱外科收治单节段CDH患者60例,随机数字表法分为A组和B组,各30例。2组均行颈椎前路椎间盘切除融合术(ACDF),A组采用零切迹椎间融合器(Zero-P)内固定,B组采用传统融合器钢板内固定。比较2组手术疗效、手术情况,手术前后C2~7颈椎曲度、Cobb角、颈椎功能(JOA评分)、疼痛程度(NRS评分),以及并发症发生率。结果A组手术疗效优良率与B组比较差异无统计学意义(96.67%vs.90.00%,χ^(2)/P=0.268/0.605);A组手术时间、透视次数、住院时间均少于B组(t/P=3.947/<0.001、2.744/0.008、3.310/0.002);2组术后3个月、6个月C2~7颈椎曲度、Cobb角均高于术前(P<0.001),但2组间比较差异无统计学意义(P>0.05);2组术后3个月、6个月JOA评分均高于术前,NRS评分均低于术前(P<0.001),但2组间比较差异无统计学意义(P>0.05);A组并发症发生率低于B组(6.67%vs.26.67%,χ^(2)/P=4.320/0.038)。结论单节段CDH患者ACDF中采用Zero-P或传统融合器钢板内固定,均能获得良好手术疗效,有效改善颈椎解剖结构及功能,减轻疼痛程度,其中Zero-P在缩短手术时间、促进患者术后恢复方面具有明显优势,同时能降低并发症发生率。

Objective To observe the effect of different surgical methods on cervical disc herniation(CDH)and its influence on cervical curvature,adjacent segment degeneration and safety.Methods From June 2019 to June 2022,60 patients with single-segment CDH were randomly divided into group A and group B with 30 patients in each group.Both groups were treated with anterior cervical discectomy and fusion(ACDF),group A was treated with Zero-P internal fixation,and group B was treated with traditional fusion cage plate internal fixation.The operation efficacy,operation condition,C2~7 cervical curvature,Cobb angle,cervical function(JOA score),pain degree(NRS score)and complication rate of the two groups were compared before and after the operation.Results There was no statistically significant difference in the excellent and good rate of surgical effect between Group A and Group B(96.67%vs.90.00%,χ^(2)/P=0.268/0.605).The operation time,fluoroscopy times and hospital stay in Group A were less than those in Group B(t/P=3.947/<0.001,2.744/0.008,3.310/0.002).The curvature and Cobb angle of C2-7 cervical spine in the two groups were higher than those before operation 3 and 6 months after operation(P<0.001),but there was no significant difference between the two groups(P>0.05).The JOA score of the two groups at 3 and 6 months after operation was higher than that before operation,and the NRS score was lower than that before operation(P<0.001),but there was no statistically significant difference between the two groups(P>0.05).The incidence of complications in group A was lower than that in group B(6.67%vs.26.67%,χ^(2)/P=4.320/0.038).Conclusion Zero-P or traditional fusion cage plate internal fixation in ACDF of single-segment CDH patients can achieve good surgical effect,effectively improve the anatomical structure and function of cervical spine,and reduce the degree of pain.Zero-P has obvious advantages in shortening the operation time,promoting the postoperative recovery of patients,and reducing the incidence of complications.