摘要
目的 对比颈前路脊髓减压后应用钉板系统与零切迹椎间融合器（Zero-P）治疗脊髓型颈椎病的临床效果。方法 2010年10月至2013年5月, 按纳入及排除标准共47例单或双节段脊髓型颈椎病患者入组进行前瞻性随机对照研究。随机分为钉板组（颈前路椎间盘切除减压, 融合器植入、钉板系统内固定术, 26例）和零切迹组（颈前路椎间盘切除减压, 零切迹椎间融合器椎间固定融合术, 21例）。记录两组手术时间、术中出血量、术后引流量、术后吞咽不适的发生率及持续时间；手术前后按日本矫形外科学会（Japanese Orthopaedic Association, JOA）评分标准评定神经功能, 并计算改善率；颈椎侧位 X 线片测量颈椎 Cobb 角, 根据术后动力位 X 线片观察手术间隙有无异常活动, 评价术后植骨融合及内固定相关并发症情况。结果 钉板组手术时间为（71.2±26.8） min, 零切迹组为（53.4±28.6） min, 差异有统计学意义。钉板组术中出血量（78.1±46.7） ml, 术后引流量（63.3±37.7） ml；零切迹组术中出血量（77.5±50.4） ml, 术后引流量（60.7±28.6） ml, 差异均无统计学意义。术后3周钉板组5例（19.2%）仍存在吞咽困难、零切迹组0例。所有患者均获得随访, 随访时间12~42个月, 平均（23±2.16）个月, 末次随访时两组神经功能均明显改善, 钉板组JOA评分由术前的（8.25±1.23）分增加至末次随访时的（14.28±2.96）分, 改善率68.91%±7.9%；零切迹组JOA评分由术前的（8.13±1.58）分增加至末次随访时的（14.32±2.87）分, 改善率69.79%±11.2%, 差异均无统计学意义。钉板组末次随访颈椎曲度为15.2°±5.7°；零切迹组为18.1°±7.9°, 差异有统计学意义。末次随访时所有患者均植骨融合。结论 零切迹椎间融合器治疗单或双节段脊髓型颈椎病, 与传统的钉板系统相比, 可以缩短手术时间、减少术后慢性吞咽不适的发生率, 有利于颈椎曲度的维持。
Objective Compare the clinical efficacy between anterior cervical decompressions, internal fixation with steel plate and zero profile interbody fusion system （Zero-P） in the treatment of cervical spondylotic myelopathy. Methods From October 2010 to May 2013, a total of 47 patients with cervical myelopathy were included in prospective randomized controlled study. All patients were randomly divided into two groups, respectively using plate fixation （screw plate system group, 26 cases） and Zero-P （Zero-P group, 21 cases）. Compared operation time, intraoperative blood loss, postoperation flow and the incidence of postoperative discomfort swallowing. Evaluated the Japanese Orthopaedic Association （JOA） score of nerve function and calculated improvement rate; measured cervical Cobb Angle on X-ray film, observed abnormal activity of surgical clearance, evaluated degree of bone graft fusion and related internal fixation complications. Results The average operation time of screw plate system group was 71.2±26.8 min, which was 53.4±28.6 min in Zero-P group, significant difference was found in two groups. The average bleeding volume was 78.1±46.7 ml, and average volume of postoperation drainage was 63.3±37.7 ml in screw plate system group; the average bleeding volume was 77.5±50.4 ml, and the average volume of postoperation drainage was 60.7±28.6 ml in Zero-P group, no significant difference was found. 5 cases in screw plate system group remained swallowing discomfort 3 weeks after operation, but non in Zero-P group. Followed-up lasted for 24-42 months, an average of 23±2.16 months, nerve function were significantly improved at the end of the follow-up of both two groups, the JOA score of screw plate system group was 14.28±2.96, the improvement rate was 68.91%±7.9%, and Zero-P group was 14.32±2.87, the improvement rate was 69.79%±11.2%, there were no significant difference; curvature of cervical vertebrae of screw plate system group was 15.2°±5.7° at the end of follow-up; Zero-P group was 18.1°±7.9°, which with significant difference. Bone graft fusion were found in all patients at the end of follow-up, and no abnormal activities and fixation loosening was found during follow-up period. Conclusion Zero-P compared with traditional fracture-fixation techniques in treating single or double segments of cervical spondylotic myelopathy, can shorten operation time, reduce the incidence of postoperative chronic discomfort swallowing, and maintain in favour of cervical curvature.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2015年第11期1136-1141,共6页
Chinese Journal of Orthopaedics
