颈前路椎间盘切除植骨融合术联合可吸收板内固定治疗脊髓型颈椎病的近期疗效研究
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摘要
目的研究颈前路椎间盘切除植骨融合术(ACDF)联合可吸收板内固定治疗脊髓型颈椎病(CSM)的近期临床疗效。方法回顾性分析2014-01-2015-01我院接受ACDF治疗的62例CSM患者临床资料,其中,31例应用可吸收板内固定为A组,31例采用传统钛合金钉板系统固定为B组。随访评估和比较两组的JOA评分、VAS评分、颈椎生理曲度及功能等指标变化。结果术后3、6、12个月及末次随访时,两组的JOA、VAS、NDI评分、颈椎曲度及椎间高度均较术前显著改善(P<0.05),两组间比较无明显差异(P>0.05);末次随访,A组的Odom优良率为90.32%,与B组的93.55%比较差异无统计学意义(P>0.05);A组术后MRI图像伪影面积显著低于B组(P<0.05);B组ASD发生率为12.90%,而A组未见ASD发生,组间比较差异有统计学意义(P<0.05)。结论 ACDF联合可吸收板内固定治疗CSM的近期疗效确切,可降低术后MRI伪影干扰及ASD发生风险。
Objective To investigate the short-term effects of anterior cervical discectomy and fusion(ACDF) combined with bioabsorbable plate fixation in the treatment of cervical spondylotic myelopathy(CSM). Methods The clinical data of 62 patients with CSM who underwent ACDF in our hospital from January 2014 to January 2015 were retrospectively analyzed, of whom 31 patients underwent ACDF and bioabsorbable plate fixation treatment as group A, 31 patients underwent ACDF and traditional titanium alloy plate system treatment as group B. The JOA score, VAS score, the changes of cervical lordosis and function in the two groups were evaluated and compared. Results The JOA, VAS,NDI scores, cervical curve and intervertebral height at the 3 rd,6 th,12 th month after operation and last follow-up in two groups were significantly better than before operation(P <0.05),there were no significant differences between the two groups(P >0.05). At the end of follow-up, the Odom excellent rate in group A was 90.32%, that in group B was 93.55%, the difference was not statistically significant(P>0.05). The postoperative MRI imaging artifacts in group A was significantly smaller than group B(P <0.05). The difficulty swallowing, adjacent segment degeneration(ASD)incidence rate between the two groups had no significant difference(P >0.05). Conclusion ACDF combined with bioabsorbable plate fixation in the treatment of CSM has reliable short-term effect, it can reduce postoperative MRI artifacts interference and risk of ASD occurrence.
Objective To investigate the short-term effects of anterior cervical discectomy and fusion(ACDF) combined with bioabsorbable plate fixation in the treatment of cervical spondylotic myelopathy(CSM). Methods The clinical data of 62 patients with CSM who underwent ACDF in our hospital from January 2014 to January 2015 were retrospectively analyzed, of whom 31 patients underwent ACDF and bioabsorbable plate fixation treatment as group A, 31 patients underwent ACDF and traditional titanium alloy plate system treatment as group B. The JOA score, VAS score, the changes of cervical lordosis and function in the two groups were evaluated and compared. Results The JOA, VAS,NDI scores, cervical curve and intervertebral height at the 3 rd,6 th,12 th month after operation and last follow-up in two groups were significantly better than before operation(P <0.05),there were no significant differences between the two groups(P >0.05). At the end of follow-up, the Odom excellent rate in group A was 90.32%, that in group B was 93.55%, the difference was not statistically significant(P>0.05). The postoperative MRI imaging artifacts in group A was significantly smaller than group B(P <0.05). The difficulty swallowing, adjacent segment degeneration(ASD)incidence rate between the two groups had no significant difference(P >0.05). Conclusion ACDF combined with bioabsorbable plate fixation in the treatment of CSM has reliable short-term effect, it can reduce postoperative MRI artifacts interference and risk of ASD occurrence.
引文
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[11]郑伟东,李亮,章培标,等.左旋聚乳酸颈椎可吸收固定板的力学性能测试[J].中国组织工程研究与临床康复,2010,14(12):2191-2194.
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[13]Nabhan A,Ishak B,Steimer O,et al.Comparison of bioresorbable and titanium plates in cervical spinal fusion:early radiologic and clinical results[J].J Spinal Disord Tech.2009;22(3):155-161.
[14]Tomasino A,Gebhard H,Parikh K,et a1.Bioabsorbable instrumentation for single-level cervical degenerative disc disease:A radiological and clinical outcome study-Clinical article[J].J Neurosurg Spine,2009,11(5):529-537.
[15]张大明,吕游,张洪鑫,等.可吸收钉板在颈椎前路椎体次全切除术中的应用研究[J].生物骨科材料与临床研究,2015,12(5):55-57.
[2]李程,王冰,王一宇,等.两种前路手术治疗邻近双节段脊髓型颈椎病的临床效果[J].中国脊柱脊髓杂志,2015,25(5):433-437.
[3]陈朦村,杨述华,杨操,等.可吸收固定板在脊髓型颈椎病前路减压融合术中的应用[J].中华骨科杂志,2015,35(6):602-609.
[4]李增春,陈德玉,吴德升,等.第三届全国颈椎病专题座谈会纪要[J].中华外科杂志,2008,46(23):1796-1799.
[5]李涛,李志丹,肖启贤,等.颈前路椎体次全切除钛网植骨锁定钢板内固定术治疗双节段脊髓型颈椎病[J].临床骨科杂志,2015,18(1):15-17,22.
[6]沈雄杰,黄象望,张毅,等.颈椎前路减压钛网植骨融合术后内固定早期失败原因及预防[J].医学临床研究,2012,29(2):267-270.
[7]Rodrigo V,Maza A,Calatayud JB,et al.Long-term follow-up of anterior cervical discectomy and fusion with bioabsorbable plates and screws[J].Clin Neurol Neurosurg,2015,136(9):116-121.
[8]Aryan HE,Lu DC,Acosta-FL Jr,et al.Bioabsorbable anterior cervical plating:initial multicenter clinical and radiographic experience[J].Spine,2007,32(10):1084-1088.
[9]杨海松,陈德玉,史建刚,等.生物型可吸收颈椎前路钉板系统应用于单节段颈椎病的初步临床研究[J].中国脊柱脊髓杂志,2015,25(4):304-310.
[10]Whitmore RG,Tykocinski ES,Sanborn MR,et al.Bioresorbable anterior cervical plate device for multi-level degenerative disc disease:case report with 8-year follow-up[J].J Clin Neurosci,2011,18(12):1736-1738.
[11]郑伟东,李亮,章培标,等.左旋聚乳酸颈椎可吸收固定板的力学性能测试[J].中国组织工程研究与临床康复,2010,14(12):2191-2194.
[12]Daentzer D,Floerkemeier T,Bartsch I,el al.Preliminary results in anterior cervical discectomy and fusion with an experimental bioabsorbable cage-clinical and radiological findings in an ovine animal model[J].Springerplus,2013,2(1):1-8.
[13]Nabhan A,Ishak B,Steimer O,et al.Comparison of bioresorbable and titanium plates in cervical spinal fusion:early radiologic and clinical results[J].J Spinal Disord Tech.2009;22(3):155-161.
[14]Tomasino A,Gebhard H,Parikh K,et a1.Bioabsorbable instrumentation for single-level cervical degenerative disc disease:A radiological and clinical outcome study-Clinical article[J].J Neurosurg Spine,2009,11(5):529-537.
[15]张大明,吕游,张洪鑫,等.可吸收钉板在颈椎前路椎体次全切除术中的应用研究[J].生物骨科材料与临床研究,2015,12(5):55-57.