创伤性椎间盘突出脊髓损伤两种颈椎前路融合

Two types of instrumented anterior cervical decompression and fusion for traumatic disc herniation accompanied with spi⁃nal cord injury

[目的]比较零切迹锁定型颈椎融合器(zero-profile, stand-alone cervical cage, ROI-C)与传统颈椎前路椎间融合器联合钛板(cage and plate, CP)治疗创伤性椎间盘突出伴脊髓损伤的临床效果。[方法]回顾性分析2015年9月—2020年9月收治的44例接受颈椎前路手术治疗的创伤性椎间盘突出伴脊髓损伤患者。依据医患沟通结果,21例采用ROI-C,23例采用CP。比较两组围手术期、随访及影像结果。[结果]两组患者手术均顺利,无严重术中并发症。ROI-C组手术时间、切口长度、术中透视次数、术中失血量、下地行走时间及住院时间均显著优于CP组(P<0.05)。两组患者随访时间平均(16.8±3.2)个月,ROI-C组恢复完全负重活动时间显著早于CP组(P<0.05)。随时间推移,两组ASIA评级、JOA评分、NDI评分及锥体术征情况均显著改善(P<0.05)。术前两组患者上述指标的差异均无统计学意义(P>0.05),术后1、3个月,ROI-C组ASIA评级显著优于CP组(P<0.05)。影像方面,术后两组患者C2~7Cobb角和椎间隙高度均较术前显著改善(P<0.05),术前两组上述影像指标的差异均无统计学意义(P>0.05),术后相应时间点ROI-C组椎间隙高度显著优于CP组(P<0.05)。术后3个月,ROI-C组椎体间融合情况优于CP组(P<0.05)。[结论]对于创伤性椎间盘突出伴脊髓损伤,两种术式均能改善神经功能,改善颈椎生理曲度和维持椎间隙高度。与传统CP相比,ROI-C组具有创伤小、手术时间短等优点,而且恢复患者颈椎椎间隙高度效果明显。

[Objective]To compare the clinical outcomes of zero-profile stand-alone cervical cage(ROI-C)versus conventional cage and plate(CP)used in anterior cervical decompression and fusion(ACDF)for traumatic disc herniation accompanied with spinal cord inju⁃ry.[Methods]A retrospective study was performed on 44 patients who received ACDF for traumatic disc herniation with spinal cord injury in our department from September 2015 to September 2020.According to doctor-patient communication,21 patients received ACDF with ROI-C,while the remaining 23 patients had conventional CP used.The perioperative,follow-up and imaging data were compared between the two groups.[Results]All patients in both groups had operation performed successfully without serious intraoperative complications.The ROI-C group proved significantly superior to the CP group in terms of operation time,incision length,intraoperative fluoroscopy times,in⁃traoperative blood loss,postoperative walking time and hospital stay(P<0.05).All of them were followed up for(16.8±3.2)months on an av⁃erage,and the ROI-C group resumed full weight-bearing activities significantly earlier than the CP group(P<0.05).The ASIA grade for neurological function,JOA and NDI scores and pyramidal signs improved significantly over time in both groups(P<0.05).Although there were no statistically significant differences in the abovesaid items between the two groups before surgery(P>0.05),the ROI-C group proved significantly superior to the CP group in term of ASIA grade 1 and 3 months after operation(P<0.05).Regarding imaging,postoperative C2~7 Cobb angle and intervertebral height significantly improved in both groups compared with those before surgery(P<0.05),which was not sta⁃tistically significant between the two groups before surgery(P>0.05),the ROI-C group got significantly higher intervertebral space height than the CP group at all time points postoperatively(P<0.05).In addition,the ROI-C group had significantly better intervertebral fusion than the CP group three months after surgery(P<0.05).[Conclusion]Both procedures do improve neurological function,improve cervical physiological curvature,and maintain intervertebral height for traumatic disc herniation with spinal cord injury.Compared with traditional CP,the ROI-C has the advantages of less trauma and shorter operation time,and more obvious effect of restoring the height of cervical inter⁃vertebral space.