颈椎前路减压Zero-P椎间植骨融合与钛板螺钉内固定Cage融合治疗单节段神经根型颈椎病的疗效比较
|
摘要
目的探讨颈椎前路减压零切迹椎间融合(Zero profile interbody fusion cage,Zero-P)系统与钛板螺钉内固定Cage融合系统治疗单节段神经根型颈椎病的临床疗效。方法选取2015-02至2016-12江苏省高邮市人民医院骨科收治的32例单节段神经根型颈椎病患者为研究对象,按手术方式不同分为观察组(n=20)和对照组(n=12),观察组应用Zero-P内固定系统,对照组应用钛板螺钉内固定Cage融合系统。比较两组患者手术一般情况(手术时间、出血量、住院时间),功能恢复情况[疼痛视觉模拟评分(visual analogue score,VAS)、日本骨科学会(Japanese Orthopedics Association,JOA)评分],影像学评估情况(手术节段融合率及术前、术后融合节段Cobb角),并记录并发症情况。结果 (1)手术一般情况:观察组手术时间短于对照组(Z=1.67,P=0.012),出血量少于对照组(Z=1.23,P=0.024),但两组患者住院时间比较,差异无统计学意义(t=0.29,P=0.516)。(2)功能恢复情况:组内比较,两组患者术后3 d及末次随访时的VAS和JOA评分均高于术前,差异有统计学意义(P<0.05);组间比较,观察组与对照组在术前、术后3 d、末次随访三个时间点的VAS、JOA评分比较,差异均无统计学意义(P>0.05)。(3)影像学评估情况:两组末次随访的融合率比较,差异无统计学意义(χ~2=1.45,P>0.05);组内比较,观察组患者融合节段的Cobb角在术后3 d及末次随访时较术前明显改善,差异有统计学意义(P<0.05);组间比较,观察组患者术后3 d及末次随访时的融合节段Cobb角改善情况均优于对照组同时间点,差异有统计学意义(t=3.64,P=0.013;t=4.31,P=0.009)。(4)并发症情况:两组术后吞咽困难发生率比较,差异有统计学意义(χ~2=3.62,P<0.05)。结论 Zero-P内固定系统与颈前路钛板联合Cage系统治疗单节段神经根型颈椎病均具有确切的临床疗效,二者在神经功能恢复及疼痛改善上都有良好效果,并无显著性差异。但前者具有手术创伤小、手术时间短、术中出血少、操作步骤简便、颈椎生理曲度改善明显、术后吞咽困难发生率低等优势。
Objective The objective of this study was to compare the clinical efficacy of anterior cervical decompression with Zero-P intervertebral fusion and titanium plate fixation with Cage fusion in the treatment of single-segment cervical spondylotic radiculopathy.Methods A total of 32 cases of single-segment cervical spondylotic radiculopathy treated in Orthopaedics Department of Gaoyou People's Hospital of Jiangsu province from February 2015 to December 2016 were selected as the objects. They were divided into observation group(n=20) and control group(n=12) based on the operation methods. The observation group was given Zero-P internal fixation system, while the control group was treated by titanium plate fixation with Cage fusion. The general conditions of operation(operation time, amount of intraoperative bleeding, length of hospitalization), functional recovery [visual analogue score(VAS), Japanese Orthopedics Association score(JOA)], imaging evaluation(surgical segmental fusion rate and Cobb angle of fusion segment before and after operation) were compared between the two groups. Postoperative complications were recorded. Results(1) General situation of operation: The operation time of the observation group was shorter than that of the control group(Z=1.67, P=0.012), and the amount of bleeding was less than that of the control group(Z=1.23, P=0.024). There was no significant difference in the hospitalization time between the two groups(t=0.29, P=0.516).(2) Functional recovery: The VAS and JOA scores of the two groups at 3 d after operation and at the last follow-up were higher than those before operation(P<0.05). There was no significant difference in VAS and JOA scores between the two group at three time points of before operation, 3 d after operation and the last follow-up(P>0.05).(3) Imaging evaluation: There was no significant difference in the fusion rate between the two groups at the last follow-up(χ~2=1.45, P>0.05). The Cobb angle of fusion segment in the observation group was significantly improved at 3 d after operation and at the last follow-up, and the difference was statistically significant(P<0.05). At 3 d after the operation and the last follow-up, the improvement of Cobb angle of fusion segment was better than that of control group at the same time point, and the difference was statistically significant(t=3.64, P=0.013; t=4.31, P=0.009).(4) Complications: The incidence of dysphagia was significantly different between the two groups(χ~2= 3.62, P<0.05). Conclusions Both anterior cervical decompression with Zero-P intervertebral fusion and titanium plate fixation with Cage fusion are effective in the treatment of single-segment cervical spondylotic radiculopathy, recovering nerve function and relieving pain. The former has minor wound, shorter operation time, less bleeding, ease of operation procedure, and can improve cervical physiological curvature and reduce the incidence of dysphagia.
Objective The objective of this study was to compare the clinical efficacy of anterior cervical decompression with Zero-P intervertebral fusion and titanium plate fixation with Cage fusion in the treatment of single-segment cervical spondylotic radiculopathy.Methods A total of 32 cases of single-segment cervical spondylotic radiculopathy treated in Orthopaedics Department of Gaoyou People's Hospital of Jiangsu province from February 2015 to December 2016 were selected as the objects. They were divided into observation group(n=20) and control group(n=12) based on the operation methods. The observation group was given Zero-P internal fixation system, while the control group was treated by titanium plate fixation with Cage fusion. The general conditions of operation(operation time, amount of intraoperative bleeding, length of hospitalization), functional recovery [visual analogue score(VAS), Japanese Orthopedics Association score(JOA)], imaging evaluation(surgical segmental fusion rate and Cobb angle of fusion segment before and after operation) were compared between the two groups. Postoperative complications were recorded. Results(1) General situation of operation: The operation time of the observation group was shorter than that of the control group(Z=1.67, P=0.012), and the amount of bleeding was less than that of the control group(Z=1.23, P=0.024). There was no significant difference in the hospitalization time between the two groups(t=0.29, P=0.516).(2) Functional recovery: The VAS and JOA scores of the two groups at 3 d after operation and at the last follow-up were higher than those before operation(P<0.05). There was no significant difference in VAS and JOA scores between the two group at three time points of before operation, 3 d after operation and the last follow-up(P>0.05).(3) Imaging evaluation: There was no significant difference in the fusion rate between the two groups at the last follow-up(χ~2=1.45, P>0.05). The Cobb angle of fusion segment in the observation group was significantly improved at 3 d after operation and at the last follow-up, and the difference was statistically significant(P<0.05). At 3 d after the operation and the last follow-up, the improvement of Cobb angle of fusion segment was better than that of control group at the same time point, and the difference was statistically significant(t=3.64, P=0.013; t=4.31, P=0.009).(4) Complications: The incidence of dysphagia was significantly different between the two groups(χ~2= 3.62, P<0.05). Conclusions Both anterior cervical decompression with Zero-P intervertebral fusion and titanium plate fixation with Cage fusion are effective in the treatment of single-segment cervical spondylotic radiculopathy, recovering nerve function and relieving pain. The former has minor wound, shorter operation time, less bleeding, ease of operation procedure, and can improve cervical physiological curvature and reduce the incidence of dysphagia.
引文
[1]Kang S H, Kim D K, Seo K M, et al. Multi-level spinal fusion and postoperative prevertebral thickness increase the risk of dysphagia after anterior cervical spine surgery[J]. J Clin Neurosci, 2011, 18(10):1369-1373. DOI:10.1016/j.jocn.2011.02.033.
[2]冷华平,段永壮,李宽宽,等.颈前路减压Zero-P椎间植骨融合内固定治疗单节段神经根型颈椎病的疗效及影像学分析[J].中国骨与关节损伤杂志, 2018, 33(5):454-457.
[3]彭爱明,刘果,俞勇,等.颈椎前路减压Cage与Zero-P椎间植骨融合内固定治疗单节段脊髓型颈椎病的疗效比较[J].中国骨与关节损伤杂志, 2017, 32(11):1121-1123. DOI:10.7531/j.issn.1672-9935.2017.11.001.
[4]Bazaz R, Lee M J, Yoo J U. Incidence of dysphagia after anterior cervical spine surgery:a prospective study[J].Spine(Phila Pa 1976), 2002, 27(22):2453-2458. DOI:10.1097/01.BRS.0000031407.52778.4B.
[5]Sholz M, Schnake K J, Pingel A, et al. A new Zero-profile implant for stand-alone anterior cervical interbody fusion[J]. Clin Orthop Relat Res, 2011, 469(3):666-673. DOI:10.1007/s11999-010-1597-9.
[6]Chung J Y, Kim S K, Jung S T, et al. Clinical adjacentsegment pathology after anterior cervical discectomy and fusion:results after a minimum of 10-year follow-up[J].Spine J, 2014, 14(10):2290-2298. DOI:10.1016/j.spinee.2014.01.027.
[7]Cho H J, Hur J W, Lee J B, et al. Cervical stand-alone polyethere-therketone cage versus Zero-Profile anchored spacer in single-level anterior cervical discectomy and fusion:minimum 2-year assessment of radiographic and clinical outcome[J]. J Korean Neurosurg Soc, 2015, 58(2):119-124. DOI:10.3340/jkns.2015.58.2.119.
[8]Alimi M, Njoku I, Hofstetter C P, et al. Anterior cervical discectomy and fusion(ACDF):comparison between Zero Profile implants and anterior cervical plate and spacer[J].Cureus, 2016, 8(4):e573-e580. DOI:10.7759/cureus.573.
[9]徐浩钦,蒋登学,高春华,等.颈前路椎间盘切除Zero-P椎间融合与钛板螺钉内固定Cage融合治疗颈椎病的疗效比较[J].中华灾害救援医学, 2017, 5(5):266-270. DOI:10.13919/j.issn.2095-6274.2017.05.007.
[10]邵海宇,张骏,杨迪,等.零切迹颈椎前路融合固定系统与传统融合器钢板内固定系统治疗单节段颈椎间盘突出症的病例对照研究[J].中国骨伤, 2016, 29(6):530-537. DOI:10.3969/j.issn.1003-0034.2016.06.011.
[11]Wang Z, Jiang W, Li X, et al. The application of ZeroProfile anchored spacer in anterior cervical discectomy and fusion[J]. Eur Spine J, 2015, 24(1):148-154. DOI:10.1007/s00586-014-3628-9. Epub 2014 Oct 22.
[12]Shin J S, Oh S H, Cho P G. Surgical outcome of a Zeroprofile device comparing with stand-alone cage and anterior cervical plate with iliac bone graft in the anterior cervical discectomy and fusion[J]. Korean J Spine, 2017,11(3):169-177. DOI:10.14245/kjs.2014.11.3.169.
[13]Dong J, Lu M, Lu T, et al. Meta-analysis comparing ZeroProfile spacer and anterior plate in anterior cervical fusion[J]. PLoS One, 2015, 10(6):e0130223. DOI:10.1371/journal.pone.0130223.
[14]章庆峻,茹江英,姜景辉,等.颈前路单间隙Zero-P与Cage钛板内固定融合术的疗效比较[J].中国矫形外科杂志, 2015, 23(1):31-34. DOI:10.3977/j.issn.1005-8478.2015.01.06.
[15]Hofstetter C P, Kesavabhotla K. Zero-Profile anchored spacer reduces rate of dysphagia compared with ACDF with anterior plating[J]. J Spinal Disord Tech, 2015, 28(5):e284-e290.
[16]Wang Z, Zhu R, Yang H, et al. Zero-profile implant(Zero-p)versus plate cage benezech implant(PCB)in the treatment of single-level cervical spondylotic myelopathy[J]. BMC Musculoskelet Disord, 2015, 16:290. DOI:10.1186/s12891-015-0746-4.
[17]Yin M, Ma J, Huang Q, et al. The new Zero-P implant can effectively reduce the risk of postoperative dysphagia and complications compared with the traditional anterior cage and plate:a systematic review and meta-analysis[J]. BMC Musculoskelet Disord, 2016, 17(1):430. DOI:10.1186/s12891-016-1274-6.
[2]冷华平,段永壮,李宽宽,等.颈前路减压Zero-P椎间植骨融合内固定治疗单节段神经根型颈椎病的疗效及影像学分析[J].中国骨与关节损伤杂志, 2018, 33(5):454-457.
[3]彭爱明,刘果,俞勇,等.颈椎前路减压Cage与Zero-P椎间植骨融合内固定治疗单节段脊髓型颈椎病的疗效比较[J].中国骨与关节损伤杂志, 2017, 32(11):1121-1123. DOI:10.7531/j.issn.1672-9935.2017.11.001.
[4]Bazaz R, Lee M J, Yoo J U. Incidence of dysphagia after anterior cervical spine surgery:a prospective study[J].Spine(Phila Pa 1976), 2002, 27(22):2453-2458. DOI:10.1097/01.BRS.0000031407.52778.4B.
[5]Sholz M, Schnake K J, Pingel A, et al. A new Zero-profile implant for stand-alone anterior cervical interbody fusion[J]. Clin Orthop Relat Res, 2011, 469(3):666-673. DOI:10.1007/s11999-010-1597-9.
[6]Chung J Y, Kim S K, Jung S T, et al. Clinical adjacentsegment pathology after anterior cervical discectomy and fusion:results after a minimum of 10-year follow-up[J].Spine J, 2014, 14(10):2290-2298. DOI:10.1016/j.spinee.2014.01.027.
[7]Cho H J, Hur J W, Lee J B, et al. Cervical stand-alone polyethere-therketone cage versus Zero-Profile anchored spacer in single-level anterior cervical discectomy and fusion:minimum 2-year assessment of radiographic and clinical outcome[J]. J Korean Neurosurg Soc, 2015, 58(2):119-124. DOI:10.3340/jkns.2015.58.2.119.
[8]Alimi M, Njoku I, Hofstetter C P, et al. Anterior cervical discectomy and fusion(ACDF):comparison between Zero Profile implants and anterior cervical plate and spacer[J].Cureus, 2016, 8(4):e573-e580. DOI:10.7759/cureus.573.
[9]徐浩钦,蒋登学,高春华,等.颈前路椎间盘切除Zero-P椎间融合与钛板螺钉内固定Cage融合治疗颈椎病的疗效比较[J].中华灾害救援医学, 2017, 5(5):266-270. DOI:10.13919/j.issn.2095-6274.2017.05.007.
[10]邵海宇,张骏,杨迪,等.零切迹颈椎前路融合固定系统与传统融合器钢板内固定系统治疗单节段颈椎间盘突出症的病例对照研究[J].中国骨伤, 2016, 29(6):530-537. DOI:10.3969/j.issn.1003-0034.2016.06.011.
[11]Wang Z, Jiang W, Li X, et al. The application of ZeroProfile anchored spacer in anterior cervical discectomy and fusion[J]. Eur Spine J, 2015, 24(1):148-154. DOI:10.1007/s00586-014-3628-9. Epub 2014 Oct 22.
[12]Shin J S, Oh S H, Cho P G. Surgical outcome of a Zeroprofile device comparing with stand-alone cage and anterior cervical plate with iliac bone graft in the anterior cervical discectomy and fusion[J]. Korean J Spine, 2017,11(3):169-177. DOI:10.14245/kjs.2014.11.3.169.
[13]Dong J, Lu M, Lu T, et al. Meta-analysis comparing ZeroProfile spacer and anterior plate in anterior cervical fusion[J]. PLoS One, 2015, 10(6):e0130223. DOI:10.1371/journal.pone.0130223.
[14]章庆峻,茹江英,姜景辉,等.颈前路单间隙Zero-P与Cage钛板内固定融合术的疗效比较[J].中国矫形外科杂志, 2015, 23(1):31-34. DOI:10.3977/j.issn.1005-8478.2015.01.06.
[15]Hofstetter C P, Kesavabhotla K. Zero-Profile anchored spacer reduces rate of dysphagia compared with ACDF with anterior plating[J]. J Spinal Disord Tech, 2015, 28(5):e284-e290.
[16]Wang Z, Zhu R, Yang H, et al. Zero-profile implant(Zero-p)versus plate cage benezech implant(PCB)in the treatment of single-level cervical spondylotic myelopathy[J]. BMC Musculoskelet Disord, 2015, 16:290. DOI:10.1186/s12891-015-0746-4.
[17]Yin M, Ma J, Huang Q, et al. The new Zero-P implant can effectively reduce the risk of postoperative dysphagia and complications compared with the traditional anterior cage and plate:a systematic review and meta-analysis[J]. BMC Musculoskelet Disord, 2016, 17(1):430. DOI:10.1186/s12891-016-1274-6.