应用零切迹椎间融合器对颈椎前路椎间盘切除及融合术后并发症的影响
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摘要
目的探讨零切迹椎间融合器对颈椎前路椎间盘切除及融合术后并发症的影响。方法回顾性的分析2014年8月至2018年8月于南京医科大学附属无锡人民医院行颈椎前路椎间盘切除及融合术治疗的74例患者,其中观察组40例应用零切迹椎间融合器,余观察组34例应用钛板联合cage融合器。采用日本骨科学会(JOA)评分评估两组患者的手术效果,随访记录两组患者术后并发症的发生情况。结果两组患者术前及术后末次随访JOA评分比较差异无统计学意义(P> 0. 05);观察组末次随访JOA评分显效改善率为92. 5%,而对照组为91. 2%,两组间比较差异无统计学意义(P> 0. 05)。观察组吞咽困难发生率为2. 5%明显低于对照组的20. 6%,两组间比较差异有统计学意义(P <0. 05);观察组邻近节段骨化的发生率为5. 0%明显低于对照组的23. 5%,两组间比较差异有统计学意义(P <0. 05)。结论零切迹椎间融合器相比钛板联合cage融合器手术效果相当,但零切迹椎间融合器可显著降低术后吞咽困难及邻近节段骨化的发生率。
Objective To evaluate the effect of Zero-profile interbody fusion cage on the complications of anterior cervical discectomy and fusion. Methods We retrospectively analyzed 74 patients who underwent cervical anterior cervical discectomy and fusion in our hospital from August 2014 to August 2018. Among them,40 patients in the observation group were treated with Zero-profile interbody fusion cage and 34 patients in the control group were treated with titanium plate combined with cage fusion device. The Japanese Orthopedic Association( JOA) score was used to evaluate the surgical outcomes of the two groups of patients. Follow-up was performed to record the incidence of postoperative complications in the two groups. Results There was no statistically significant difference between the two groups before and after the final follow-up( P> 0. 05). The effective improvement rate of the JOA score at the last follow-up was 92. 5% in the observation group,compared with 91. 2% in the control group. There was no statistically significant difference between the two groups( P > 0. 05). The incidence of dysphagia was 2. 5% in the observation group and 20. 6% in the control group. There was a statistically significant difference between the two groups( P < 0. 05). The incidence rate of adjacent-level ossification developmentin the observation group was 5. 0%,and that of the control group was 23. 5%. There was a statistically significant difference between the groups( P < 0. 05). Conclusion The zero-profile interbody fusion cage is equivalent to the titanium plate combined with the cage fusion device,but the zero-incision interbody fusion cage can significantly reduce the incidence of postoperative dysphagia and adjacent segmental ossification.
Objective To evaluate the effect of Zero-profile interbody fusion cage on the complications of anterior cervical discectomy and fusion. Methods We retrospectively analyzed 74 patients who underwent cervical anterior cervical discectomy and fusion in our hospital from August 2014 to August 2018. Among them,40 patients in the observation group were treated with Zero-profile interbody fusion cage and 34 patients in the control group were treated with titanium plate combined with cage fusion device. The Japanese Orthopedic Association( JOA) score was used to evaluate the surgical outcomes of the two groups of patients. Follow-up was performed to record the incidence of postoperative complications in the two groups. Results There was no statistically significant difference between the two groups before and after the final follow-up( P> 0. 05). The effective improvement rate of the JOA score at the last follow-up was 92. 5% in the observation group,compared with 91. 2% in the control group. There was no statistically significant difference between the two groups( P > 0. 05). The incidence of dysphagia was 2. 5% in the observation group and 20. 6% in the control group. There was a statistically significant difference between the two groups( P < 0. 05). The incidence rate of adjacent-level ossification developmentin the observation group was 5. 0%,and that of the control group was 23. 5%. There was a statistically significant difference between the groups( P < 0. 05). Conclusion The zero-profile interbody fusion cage is equivalent to the titanium plate combined with the cage fusion device,but the zero-incision interbody fusion cage can significantly reduce the incidence of postoperative dysphagia and adjacent segmental ossification.
引文
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[13] Wang ZD,Zhu RF,Yang HL,et al. Zero-profile implant(Zero-p)versus plate cage benezech implant(PCB)in the treatment of singlelevel cervical spondylotic myelopathy[J]. BMC Musculoskeletal Disord,2015,16:290.
[14] Shen Y,Du W,Wang LF,et al. Comparison of Zero-profile Device Versus Plate-and-Cage Implant in the Treatment of Symptomatic Adjacent Segment Disease after Anterior Cervical Discectomy and Fusion:A Minimum 2-Year Follow-Up Study[J]. World Neurosurg,2018,115:e226-e232.
[15] Dong J,Lu M,Lu T,et al. Meta-Analysis Comparing Zero-Profile Spacer and Anterior Plate in Anterior Cervical Fusion[J]. Plo S one,2015,10(6):e0130223.
[16] Kim LH,D'Souza M,Ho AL,et al. Anterior Techniques in Managing Cervical Disc Disease[J]. Cureus,2018,10(8):e3146.
[17] Schulz C,Mauer UM. PEEK cage fusion after anterior cervical corpectomy:Clinical and radiological results in patients with spondylotic myelopathy[J]. Der Orthopade,2017,46(3):242-248.
[18] Chong E,Mobbs RJ,Pelletier MH. Titanium/Polyetheretherketone Cages for Cervical Arthrodesis with Degenerative and Traumatic Pathologies:Early Clinical Outcomes and Fusion Rates[J]. Orthop Surg,2016,8(1):19-26.
[19] Lu Y,Bao W,Wang Z,et al. Comparison of the clinical effects of zero-profile anchored spacer(ROI-C)and conventional cage-plate con- struct for the treatment of noncontiguous bilevel of cervical degenerative disc disease(CDDD):A minimum 2-year follow-up[J]. Medicine,2018,97(5):e9808.
[20] Michael B,Dennis O,Scott CR,et al. The ROI-C zero-profile anchoredspacer for anterior cervical discectomy and fusion:biomechanical profile and clinical outcomes[J]. Med Devices(Auckl), 2017, 10:61-69.
[2] Lv Y,Tian W,Chen D,et al. The prevalence and associated factors of symptomatic cervical Spondylosis in Chinese adults:a communitybased cross-sectional study[J]. BMC Musculoskelet Disord,2018,19(1):325.
[3] Kim LH,D'Souza M,Ho AL,et al. Anterior Techniques in Managing Cervical Disc Disease[J]. Cureus,2018,10(8):e3146.
[4] Kim TH,Kim DH,Kim KH,et al. Can the Zero-Profile Implant Be Used for Anterior Cervical Discectomy and Fusion in Traumatic Subaxial Disc Injury? A Preliminary,Retrospective Study[J]. J Korean Neurosurg Soc,2018,61(5):574-581.
[5] Lan T,Lin JZ,Hu SY,et al. Comparison between zero-profile spacer and plate with cage in the treatment of single level cervical spondylosis[J]. J Back Musculoskelet Rehabil,2018,31(2):299-304.
[6] Albanese V,Certo F,Visocchi M. Multilevel Anterior Cervical Diskectomy and Fusion with Zero-Profile Devices:Analysis of Safety and Feasibility,with Focus on Sagittal Alignment and Impact on Clinical Outcome:Single-Institution Experience and Review of Literature[J].World Neurosurg,2017,106:724-735.
[7] Liu Y,Wang H,Li X,et al. Comparison of a zero-profile anchored spacer(ROI-C)and the polyetheretherketone(PEEK)cages with an anterior plate in anterior cervical discectomy and fusion for multilevel cervical spondylotic myelopathy[J]. Eur Spine J,2016,25(6):1881-1890.
[8] Tong MJ,Xiang GH,He ZL,et al. Zero-Profile Spacer Versus Cage-Plate Construct in Anterior Cervical Diskectomy and Fusion for Multilevel Cervical Spondylotic Myelopathy:Systematic Review and MetaAnalysis[J]. World Neurosurgery,2017,104:545-553.
[9] Chen Y,Liu Y,Chen H,et al. Comparison of Curvature Between the Zero-P Spacer and Traditional Cage and Plate After 3-Level Anterior Cervical Discectomy and Fusion:Mid-term Results[J]. Clin Spine Surg,2017,30(8):E1111-E1116.
[10] Shi S,Zheng S,Li XF,et al. Comparison of 2 Zero-Profile Implants in the Treatment of Single-Level Cervical Spondylotic Myelopathy:A Preliminary Clinical Study of Cervical Disc Arthroplasty versus Fusion[J]. Plo S one,2016,11(7):e0159761.
[11] Qizhi S,Lei S,Peijia L,et al. A Comparison of Zero-Profile Devices and Artificial Cervical Disks in Patients With 2 Noncontiguous Levels of Cervical Spondylosis[J]. Clin Spine Surg,2016,29(2):E61-E66.
[12] Yan B. Clinical comparison of Zero-profile interbody fusion device and anterior cervical plate interbody fusion in treating cervical spondylosis[J]. Int J Clin Exp Med,2015,8(8):13854-13858.
[13] Wang ZD,Zhu RF,Yang HL,et al. Zero-profile implant(Zero-p)versus plate cage benezech implant(PCB)in the treatment of singlelevel cervical spondylotic myelopathy[J]. BMC Musculoskeletal Disord,2015,16:290.
[14] Shen Y,Du W,Wang LF,et al. Comparison of Zero-profile Device Versus Plate-and-Cage Implant in the Treatment of Symptomatic Adjacent Segment Disease after Anterior Cervical Discectomy and Fusion:A Minimum 2-Year Follow-Up Study[J]. World Neurosurg,2018,115:e226-e232.
[15] Dong J,Lu M,Lu T,et al. Meta-Analysis Comparing Zero-Profile Spacer and Anterior Plate in Anterior Cervical Fusion[J]. Plo S one,2015,10(6):e0130223.
[16] Kim LH,D'Souza M,Ho AL,et al. Anterior Techniques in Managing Cervical Disc Disease[J]. Cureus,2018,10(8):e3146.
[17] Schulz C,Mauer UM. PEEK cage fusion after anterior cervical corpectomy:Clinical and radiological results in patients with spondylotic myelopathy[J]. Der Orthopade,2017,46(3):242-248.
[18] Chong E,Mobbs RJ,Pelletier MH. Titanium/Polyetheretherketone Cages for Cervical Arthrodesis with Degenerative and Traumatic Pathologies:Early Clinical Outcomes and Fusion Rates[J]. Orthop Surg,2016,8(1):19-26.
[19] Lu Y,Bao W,Wang Z,et al. Comparison of the clinical effects of zero-profile anchored spacer(ROI-C)and conventional cage-plate con- struct for the treatment of noncontiguous bilevel of cervical degenerative disc disease(CDDD):A minimum 2-year follow-up[J]. Medicine,2018,97(5):e9808.
[20] Michael B,Dennis O,Scott CR,et al. The ROI-C zero-profile anchoredspacer for anterior cervical discectomy and fusion:biomechanical profile and clinical outcomes[J]. Med Devices(Auckl), 2017, 10:61-69.