零切迹颈前路椎间融合系统治疗颈椎病的早期疗效

Early-term clinical outcome of a Zero-profile implant for anterior cervical discectomy and fusion for cervical spondylosis

背景:颈椎前路减压植骨融合已成为治疗颈椎病的有效手段,但应用钛板螺钉系统有引起吞咽困难、加速邻近节段退变等缺点。为减少以上并发症发生,零切迹颈前路椎间融合系统(Zero-PACIFC)逐步应用于临床,但其临床疗效方面的研究较少。目的目的:探讨应用Zero-P ACIFC治疗颈椎病的临床疗效。方法方法:选取2013年6月至2014年5月于我院接受Zero-P ACIFC颈前路减压植骨融合内固定术的颈椎病患者30例,年龄38~71岁,平均(58.3±4.6)岁。其中神经根型5例,脊髓型16例,混合型9例。术前及术后6周、3个月、12个月对神经根型颈椎病患者行VAS评分、脊髓型颈椎病患者行JOA评分;所有患者术前及术后6周、12个月在颈椎中立侧位X线片上测量颈椎Cobb角(C2和C7椎体后缘切线的夹角);观察术后吞咽困难的发生率以及症状持续时间。根据术后前屈后伸位X线片观察手术间隙有无异常活动。结果结果:手术时间为54~120 min,平均(72±17.3)min;术中出血量为50~170 ml,平均(80±25.2)ml。单间隙21例,两个间隙9例。共置入Zero-P ACIFC 39枚,C3/4、C4/5、C5/6、C6/7椎间隙置入Zero-P ACIFC分别为5、11、19、4枚。9例患者术后1周内出现吞咽困难,术后6周内症状全部消失。30例全部获得随访,随访时间为12~15个月,平均(13.6±0.7)个月。神经根型颈椎病患者术后6周、3个月、12个月时的VAS评分分别为(1.5±0.8)分、(1.42±0.8)分、(1.4±0.9)分,均低于术前的(7.1±1.3)分(P<0.01)。脊髓型颈椎病患者术后6周、3个月、12个月时的JOA评分分别为(14.8±1.3)分、(15.2±1.0)分、(15.1±1.2)分,均高于术前的(9.8±1.6)分(P<0.01)。术后6周及12个月颈椎Cobb角分别为18.5°±8.6°、17.8°±9.5°,均大于术前的9.0°±8.0°(P<0.01)。术后12个月时的VAS评分、JOA评分和颈椎Cobb角与术后6周比较均无统计学差异(P>0.05)。随访期间未发现内置物沉降,螺钉松动、断裂,内固定器移位等并发症。结论结论:Zero-P ACIFC颈前路减压植骨融合内固定术治疗颈椎病的早期疗效满意,稳定性可靠,可重建颈椎曲度,术后吞咽困难的发生率低。

Background: The role of anterior cervical discectomy and fusion(ACDF) in patients with cervical spondylosis has been established. But anterior plating is associated with higher rates of postoperative dysphagia and quicker degeneration of neighboring segments. Zero-profile anterior cervical interbody fusion cage(Zero-P ACIFC) is an implant that can potentially limit these drawbacks, however, there has been few literatures on it.Objective: To evaluate the early outcome of ACDF using Zero-P ACIFC in patients with cervical spondylosis.Methods: Thirty patients who underwent ACDF with Zero-P ACIFC between June 2013 and May 2014 were included in this study. The average age of the patients was(58.3±4.6) years(range, 38-71 years). There were 5 patients with radiculopathy, 16 with myelopathy and 9 with myelopathy combined with radiculopathy. Clinical outcome was evaluated using Visual Analog Scale(VAS) score for radiculopathy and Japanese Orthopaedic Association(JOA) score for myelopathy. The Cobb angle of cervical lordosis was measured by the tangent of the posterior body line of C2 and C7 on X-ray lateral view. The incidence and duration of dysphagia were recorded. Abnormality of involved segment was observed on extension and flexion lateral X-ray.Results: The average operation time was(72 ± 17.3) min(range, 54- 120 min). The average blood loss was(80 ± 25.2) ml(range, 50-170 ml). A total of 39 Zero-Ps were implanted in 21 patients with monosegmental disease and 9 with bisegmental diseases. The number of Zero-Ps implanted in the C3/4, C4/5, C5/6, C6/7 was 5, 11, 19, and 4, respectively. Dysphagia occurred within one week after surgery in 9 patients and the symptom disappeared 6 weeks postoperatively. All patients werefollowed up for(13.6±0.7) months on average(range, 12-15 months). The VAS score was 1.5±0.8, 1.42±0.8 and 1.4±0.9 at 6weeks, 3 months and 12 months after surgery, respectively, which was significantly lower than preoperative one(7.1±1.3, P<0.01). The JOA score was 14.8±1.3, 15.2±1.0 and 15.1±1.2 at 6 weeks, 3 months and 12 months after surgery, respectively,which was significantly higher than preoperative one(9.8±1.6, P<0.01). The Cobb angle was 18.5°±8.6°, and 17.8°±9.5° at6 weeks and 12 months after surgery, respectively, which was significantly larger than preoperative one(9.0°±8.0°, P<0.01).No significant differences were found in the VAS score, JOA score or Cobb angle at 6 weeks and 12 months postoperatively(P>0.05). During the follow-up, no abnormal activity at the surgical segment or implant failure were found.Conclusions: The Zero-P implant is a valid alternative to anterior cervical plating duiring ACDF with a very low incidence of postoperative dysphagia. Zero-P can also restore the cervical alignment.