ROI-C与传统融合器联合钛板内固定治疗颈椎病:颈椎稳定性重建及椎间融合的比较
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摘要
背景:颈椎前路减压融合内固定是治疗颈椎退行性疾病的经典术式,效果确切,但仍存在较多问题,以"零切迹"理念设计的ROI-C近年来临床运用也比较广泛,但其与传统术式治疗效果的比较研究较少。目的:比较分析ROI-C与传统融合器联合钛板在颈椎病前路椎间融合术中的临床疗效。方法:2012年4月至2015年12月对47例颈椎病患者开展颈椎前路减压融合内固定手术,随机分为2组,钛板组18例患者采用传统融合器联合钛板治疗,ROI-C组29例患者采用ROI-C融合器治疗。所有患者对治疗方案均知情同意,且得到医院伦理委员会批准。记录术中出血量、C臂机透视次数、手术时间、术后并发症及椎间融合情况;分别在术前及术后评估患者的疼痛目测类比评分及日本骨科协会脊髓功能评分。结果与结论:(1)术后患者均得到了门诊定期随访,时间为12-16个月,所有患者临床症状、脊髓功能明显改善,2组患者均未出现内植物松动移位及二次手术;(2)术后末次随访手术节段均获得融合,2组差异无显著性意义(P> 0.05);(3)但ROI-C组患者的手术时间、术中出血量及术中C臂机透视次数均优于钛板组(P <0.05);(4)术后2组患者的日本骨科协会评分、目测类比评分均优于术前,但术后各时间点2组间差异无显著性意义(P> 0.05);(5)提示ROI-C与传统融合器联合钛板在颈椎前路手术中均能获得较好的临床疗效,在有效恢复椎间隙高度、获得颈椎稳定性重建及椎体间融合方面无明显差异;但ROI-C组在手术时间、术中出血量以及避免因钢板置入引起的并发症方面存在明显优势,有望取代融合器联合钛板的传统手术方式。
BACKGROUND: Anterior cervical discectomy and fusion is classical and satisfactory for the treatment of cervical spondylosis, but there ar e still many problems. ROI-C designed with the concept of "zero-notch" has been widely used in clinical practice in recent years, but there are few comparative studies between ROI-C and traditional surgical treatment. OBJECTIVE: To compare and analyze the clinical effect of ROI-C and traditional fusion cage combined with titanium plate in the operation of cervical spondylosis. METHODS: From April 2012 to December 2015, 47 cases underwent anterior cervical decompression spondylotic myelopathy fusion and internal fixation surgery. They were divided into two groups. Patients in the titanium plate group(n=18) were treated by traditional fusion combined therapy with titanium plate. Patients in the ROI-C group(n=29) were treated by ROI-C fusion treatment. Informed consent was obtained from all patients. This study was approved by the Hospital Ethics Committee. Intraoperative blood loss, the number of C-arm fluoroscopy, operation time, postoperative complications and intervertebral fusion were recorded. Visual Analogue Scale score and Japanese Orthopaedic Association score were evaluated before and after operation. RESULTS AND CONCLUSION:(1) All patients were followed up regularly for 12-16 months. Clinical symptoms and spinal cord function of all patients were remarkably improved. Neither of the two groups had implant loosening or displacement or secondary surgery.(2) At the last follow-up, the operative segments were fused, but there was no significant difference between the two groups(P > 0.05).(3) Operation time, intraoperative blood loss and the number of C-arm fluoroscopy during operation were better in the ROI-C group than in the titanium plate group(P < 0.05).(4) Visual Analogue Scale score and Japanese Orthopaedic Association score were better after operation than those be fore operation in both groups, but no significant difference was found between the two groups at various time points(P > 0.05).(5) ROI-C and the traditional fusion cage with titanium plate can obtain good clinical curative effect in anterior cervical spine surgery. Ther e was no significant difference in effective recovery of intervertebral space height, cervical stability reconstruction and interbody fusion. Nevertheless, ROI-C group has obvious advantages in operation time, intraoperative blood loss and avoidance of complications caused by plate implantati on. It is hopeful that ROI-C will replace the traditional fusion cage combined with titanium plate.
BACKGROUND: Anterior cervical discectomy and fusion is classical and satisfactory for the treatment of cervical spondylosis, but there ar e still many problems. ROI-C designed with the concept of "zero-notch" has been widely used in clinical practice in recent years, but there are few comparative studies between ROI-C and traditional surgical treatment. OBJECTIVE: To compare and analyze the clinical effect of ROI-C and traditional fusion cage combined with titanium plate in the operation of cervical spondylosis. METHODS: From April 2012 to December 2015, 47 cases underwent anterior cervical decompression spondylotic myelopathy fusion and internal fixation surgery. They were divided into two groups. Patients in the titanium plate group(n=18) were treated by traditional fusion combined therapy with titanium plate. Patients in the ROI-C group(n=29) were treated by ROI-C fusion treatment. Informed consent was obtained from all patients. This study was approved by the Hospital Ethics Committee. Intraoperative blood loss, the number of C-arm fluoroscopy, operation time, postoperative complications and intervertebral fusion were recorded. Visual Analogue Scale score and Japanese Orthopaedic Association score were evaluated before and after operation. RESULTS AND CONCLUSION:(1) All patients were followed up regularly for 12-16 months. Clinical symptoms and spinal cord function of all patients were remarkably improved. Neither of the two groups had implant loosening or displacement or secondary surgery.(2) At the last follow-up, the operative segments were fused, but there was no significant difference between the two groups(P > 0.05).(3) Operation time, intraoperative blood loss and the number of C-arm fluoroscopy during operation were better in the ROI-C group than in the titanium plate group(P < 0.05).(4) Visual Analogue Scale score and Japanese Orthopaedic Association score were better after operation than those be fore operation in both groups, but no significant difference was found between the two groups at various time points(P > 0.05).(5) ROI-C and the traditional fusion cage with titanium plate can obtain good clinical curative effect in anterior cervical spine surgery. Ther e was no significant difference in effective recovery of intervertebral space height, cervical stability reconstruction and interbody fusion. Nevertheless, ROI-C group has obvious advantages in operation time, intraoperative blood loss and avoidance of complications caused by plate implantati on. It is hopeful that ROI-C will replace the traditional fusion cage combined with titanium plate.
引文
[1]Hetdecke V,Ramov NG,Marx T,et al.Outcome in cloward anterior fusion for degenerative cervical spinal disease.Acta Neurochir.2000;142(3):283-291.
[2]Sampath P,Bendebba M,Davis JD,et al.Outcome in patients with cervical radiculopathy,prospective multicenter study with indepentent clinical review.Spine.1999;24(6):591-597.
[3]Yonenobu K,Wada E,Tanaka T,et al.Japanese orthopaedic association cervical myelopathy evaluation quesionnaire(JOACMEQ):Part2.Endorsement of the alternative item.J Orthop Sci.2007;12(3):241-248.
[4]Ikenaga M,Shikata J,Tanaka C.Long-term results over 10 years of anterior corpectomy and fusion for multilevel cervical myelopathy.Spine.2006;31(14):1568-1575.
[5]Papadopoulos EC,Huang RC,Girardi FP,et al.Three-level anterior cervical discectomy and fusion with plate fixation:radiographic and clinical results.Spine.2006;31(8):897-902.
[6]Kaiser MG,Haid RW,Subach BR,et al.Anterior cervical plating enhances arthrodesis after discectomvy and fusion with cortical allograft.Neurosurgery.2002;50(2):229-238.
[7]Joseph T,King J,John JM,et al.Muhimodal assessment after surgery for cervical spondylotic myelopathy.J Neurosurgery.2005;2(5):526-534.
[8]Kim SW,Limson MA,Kim SB,et al.Comparison of radiographic changes after ACDF versus bryan disc athroplasty in sigle and bi-level cases.J Eur Spine.2009;18(2):218-231.
[9]Goffin J,Geusens E,Vantomme N,et al.Long-term follow-up after interbody fusion of the cervical spine.J Spinal Disord Tech.2004;17:79-85.
[10]Chen Y,Lu G,Wang B,et al.A comparison of anterior cervical discectomy and fusion(ACDF)using self-locking stand-alone polyetheretherketone(PEEK)cage with ACDF using cage and plate in the treatment of three-level cervical degenerative spondylopathy:a retrospective study with 2-year follow-up.Eur Spine J.2016;25(7):2255-2262.
[11]Song KJ,Choi BW,Kim JK.Adjacent segment pathology following anterior decompression and fusion using cage and plate for the treatment of degenerative cervical spinal diseases.Asian Spine J.2014;8(6):720-728.
[12]陈博来,林涌鹏,赵帅,等,零切迹自稳型颈椎融合器在颈椎前路减压融合术中的应用研究[J].中华外科杂志,2013,51(11):1046-1048.
[13]Liu W,Hu L,Wang J,et al.Comparison of zero-profile anchored spacer versus plate-cage construct in treatment of cervical spondylosis with regard to clinical outcomes and incidence of major complications:a meta-analysis.Ther Clin Risk Manag.2015;(11):1437-1447.
[14]陈德玉,贾连顺,袁文,等.颈椎前路带锁钢板临床应用的并发症及预防[J].中华骨科杂志,2001,21(5):287-289.
[15]夏展,赵兴,范顺武.颈椎前路手术并发食管瘘的诊治进展[J].中华骨科杂志,2011,31(4):384-386.
[16]Riley LH 3rd,Skolasky RL,Albert TJ,et al.Dysphagia after anterior cervical decompression and fusion:prevalence and risk factors from a longitudinal cohort study.Spine(Phila Pa 1976).2005;30(22):2564-2569.
[17]Lee MJ,Bazaz R,Furey CG,et al.Influence of anterior cervical plate design on Dysphagia:a 2-year prospective longitudinal follow-up study.J Spinal Disord Tech.2005;18(5):406-409.
[18]张宗余,姜为民,李雪峰,等.桥形椎间锁定融合器(ROI-C)在颈椎病前路减压融合术中应用的临床研究[J].中国脊柱脊髓杂志,2014,24(6):510-516.
[19]Cannada LK,Scherping SC,Yoo JU,et al.Pseudarthrosis of the cervical spine:a comparison of radiographic diagnostic measures.Spine.2003;28:46-51.
[20]Gok B,Sciubba DM,McLoughlin GS,et al.Revision surgery for cervical spondylotic myelopathy:surgical results and outcome.Neurosurgery.2008;63:292-298.
[21]蒋富贵,瞿东滨,朱志刚,等.颈椎前路减压及内固定的解剖学问题[J].中国临床解剖学杂志,2000,18(4):314-315.
[2]Sampath P,Bendebba M,Davis JD,et al.Outcome in patients with cervical radiculopathy,prospective multicenter study with indepentent clinical review.Spine.1999;24(6):591-597.
[3]Yonenobu K,Wada E,Tanaka T,et al.Japanese orthopaedic association cervical myelopathy evaluation quesionnaire(JOACMEQ):Part2.Endorsement of the alternative item.J Orthop Sci.2007;12(3):241-248.
[4]Ikenaga M,Shikata J,Tanaka C.Long-term results over 10 years of anterior corpectomy and fusion for multilevel cervical myelopathy.Spine.2006;31(14):1568-1575.
[5]Papadopoulos EC,Huang RC,Girardi FP,et al.Three-level anterior cervical discectomy and fusion with plate fixation:radiographic and clinical results.Spine.2006;31(8):897-902.
[6]Kaiser MG,Haid RW,Subach BR,et al.Anterior cervical plating enhances arthrodesis after discectomvy and fusion with cortical allograft.Neurosurgery.2002;50(2):229-238.
[7]Joseph T,King J,John JM,et al.Muhimodal assessment after surgery for cervical spondylotic myelopathy.J Neurosurgery.2005;2(5):526-534.
[8]Kim SW,Limson MA,Kim SB,et al.Comparison of radiographic changes after ACDF versus bryan disc athroplasty in sigle and bi-level cases.J Eur Spine.2009;18(2):218-231.
[9]Goffin J,Geusens E,Vantomme N,et al.Long-term follow-up after interbody fusion of the cervical spine.J Spinal Disord Tech.2004;17:79-85.
[10]Chen Y,Lu G,Wang B,et al.A comparison of anterior cervical discectomy and fusion(ACDF)using self-locking stand-alone polyetheretherketone(PEEK)cage with ACDF using cage and plate in the treatment of three-level cervical degenerative spondylopathy:a retrospective study with 2-year follow-up.Eur Spine J.2016;25(7):2255-2262.
[11]Song KJ,Choi BW,Kim JK.Adjacent segment pathology following anterior decompression and fusion using cage and plate for the treatment of degenerative cervical spinal diseases.Asian Spine J.2014;8(6):720-728.
[12]陈博来,林涌鹏,赵帅,等,零切迹自稳型颈椎融合器在颈椎前路减压融合术中的应用研究[J].中华外科杂志,2013,51(11):1046-1048.
[13]Liu W,Hu L,Wang J,et al.Comparison of zero-profile anchored spacer versus plate-cage construct in treatment of cervical spondylosis with regard to clinical outcomes and incidence of major complications:a meta-analysis.Ther Clin Risk Manag.2015;(11):1437-1447.
[14]陈德玉,贾连顺,袁文,等.颈椎前路带锁钢板临床应用的并发症及预防[J].中华骨科杂志,2001,21(5):287-289.
[15]夏展,赵兴,范顺武.颈椎前路手术并发食管瘘的诊治进展[J].中华骨科杂志,2011,31(4):384-386.
[16]Riley LH 3rd,Skolasky RL,Albert TJ,et al.Dysphagia after anterior cervical decompression and fusion:prevalence and risk factors from a longitudinal cohort study.Spine(Phila Pa 1976).2005;30(22):2564-2569.
[17]Lee MJ,Bazaz R,Furey CG,et al.Influence of anterior cervical plate design on Dysphagia:a 2-year prospective longitudinal follow-up study.J Spinal Disord Tech.2005;18(5):406-409.
[18]张宗余,姜为民,李雪峰,等.桥形椎间锁定融合器(ROI-C)在颈椎病前路减压融合术中应用的临床研究[J].中国脊柱脊髓杂志,2014,24(6):510-516.
[19]Cannada LK,Scherping SC,Yoo JU,et al.Pseudarthrosis of the cervical spine:a comparison of radiographic diagnostic measures.Spine.2003;28:46-51.
[20]Gok B,Sciubba DM,McLoughlin GS,et al.Revision surgery for cervical spondylotic myelopathy:surgical results and outcome.Neurosurgery.2008;63:292-298.
[21]蒋富贵,瞿东滨,朱志刚,等.颈椎前路减压及内固定的解剖学问题[J].中国临床解剖学杂志,2000,18(4):314-315.