Solis融合器在前路颈椎椎间融合术治疗邻椎病中的应用
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摘要
目的探讨Solis融合器在前路颈椎椎间融合术治疗邻椎病(ASD)中的应用,总结其在颈椎前路术后ASD翻修术中的临床疗效、优势及缺点。方法回顾性分析2007年4月—2016年6月收治的使用Solis融合器行颈椎前路手术后需行翻修术的12例ASD患者的临床资料,记录手术时间、术中出血量,通过患者术前、术后日本骨科学会(JOA)评分、颈椎功能障碍指数(NDI)、吞咽困难情况等评估神经功能,结合手术前后X线片、CT及MRI影像学表现评估临床疗效。结果所有患者术后随访4～114(61.8±29.3)个月。术后JOA评分、NDI均较术前明显改善,差异具有统计学意义(P <0.05)。所有患者翻修术后均未出现吞咽困难等并发症,复查颈椎正侧位X线片均证实获得骨性融合。结论 Solis融合器应用在颈椎前路手术后ASD翻修术中安全有效,具有暴露范围小、手术时间短、对原手术节段无干扰、术后吞咽困难发生率低等优点。
Objective To explore the application of Solis fusion cage in anterior cervical intervertebral fusion for adjacent segment degeneration(ASD),and to summarize its clinical efficacy,advantages and disadvantages. Methods The clinical data of 12 patients with ASD who needed revision surgery after anterior cervical surgery with Solis fusion cage from April 2007 to June 2016 were analyzed retrospectively. The operation time,intraoperative bleeding volume,preoperative and postoperative Japanese Orthopaedic Association(JOA) scores,neck disability index(NDI) and dysphagia were recorded to evaluate neurological function. The clinical efficacy was evaluated by roentgenographs,CTs and MRIs before and after operation.Results All patients were followed up for 4-114(61.8±29.3)months. JOA score and NDI were significantly improved compared with those before operation,and the differences were statistically significant(P < 0.05). No complications such as dysphagia were found in all patients after revision. Bone fusion was confirmed by roentgenographs. Conclusion Solis fusion cage is safe and effective in revision of ASD after anterior cervical spine surgery. It has the advantages of small exposure range,short operation time,no interference to the original operative segment and low incidence of dysphagia after operation.
Objective To explore the application of Solis fusion cage in anterior cervical intervertebral fusion for adjacent segment degeneration(ASD),and to summarize its clinical efficacy,advantages and disadvantages. Methods The clinical data of 12 patients with ASD who needed revision surgery after anterior cervical surgery with Solis fusion cage from April 2007 to June 2016 were analyzed retrospectively. The operation time,intraoperative bleeding volume,preoperative and postoperative Japanese Orthopaedic Association(JOA) scores,neck disability index(NDI) and dysphagia were recorded to evaluate neurological function. The clinical efficacy was evaluated by roentgenographs,CTs and MRIs before and after operation.Results All patients were followed up for 4-114(61.8±29.3)months. JOA score and NDI were significantly improved compared with those before operation,and the differences were statistically significant(P < 0.05). No complications such as dysphagia were found in all patients after revision. Bone fusion was confirmed by roentgenographs. Conclusion Solis fusion cage is safe and effective in revision of ASD after anterior cervical spine surgery. It has the advantages of small exposure range,short operation time,no interference to the original operative segment and low incidence of dysphagia after operation.
引文
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[12]Bin S,Xiangwang H,Sheng X,et al.Artificial cervical disk replacement for the treatment of adjacent segment disease after anterior cervical decompression and fusion[J].Clin Spine Surg,2017,30(5):E587-E591.
[13]O’Neill KR,Wilson RJ,Burns KM,et al.Anterior cervical discectomy and fusion for adjacent segment disease:clinical outcomes and cost utility of surgical intervention[J].Clin Spine Surg,2016,29(6):234-241.
[14]Wang F,Wang P,Miao DC,et al.Different surgical approaches for the treatment of adjacent segment diseases after anterior cervical fusion:a retrospective study of 49patients[J].Medicine(Baltimore),2017,96(23):e7042.
[15]王洪立,姜建元,吕飞舟,等.颈椎前路融合术后邻近节段退变性疾病的原因分析及治疗策略[J].中华骨科杂志,2014,34(9):915-922.
[16]Ahn SS,Paik HK,Chin DK,et al.The fate of adjacent segments after anterior cervical discectomy and fusion:the influence of an anterior plate system[J].World Neurosurg,2016,89:42-50.
[17]Helgeson MD,Bevevino AJ,Hilibrand AS.Update on the evidence for adjacent segment degeneration and disease[J].Spine J,2013,13(3):342-351.
[2]van Eck CF,Regan C,Donaldson WF,et al.The revision rate and occurrence of adjacent segment disease after anterior cervical discectomy and fusion:a study of672 consecutive patients[J].Spine(Phila Pa 1976),2014,39(26):2143-2147.
[3]Vernon H,Mior S.The neck disability index:a study of reliability and validity[J].J Manipulative Physiol Ther,1991,14(7):409-415.
[4]Yonenobu K,Abumi K,Nagata K,et al.Interobserver and intraobserver reliability of the Japanese Orthopaedic Association scoring system for evaluation of cervical compression myelopathy[J].Spine(Phila Pa 1976),2001,26(17):1890-1895.
[5]Wang JC,Mcdonough PW,Endow K,et al.The effect of cervical plating on single-level anterior cervical discectomy and fusion[J].J Spinal Disord,1999,12(6):467-471.
[6]逄川,海涌,杨晋才,等.颈椎融合术后邻近节段退变的研究现状[J].脊柱外科杂志,2013,11(2):112-114.
[7]Kong L,Cao J,Wang L,et al.Prevalence of adjacent segment disease following cervical spine surgery:a PRISMA-compliant systematic review and meta-analysis[J].Medicine(Baltimore),2016,95(27):e4171.
[8]Chung JY,Kim SK,Jung ST,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.
[9]Litrico S,Lonjon N,Riouallon G,et al.Adjacent segment disease after anterior cervical interbody fusion:a multicenter retrospective study of 288 patients with long-term follow-up[J].Orthop Traumatol Surg Res,2014,100(6 Suppl):S305-S309.
[10]Alhashash M,Shousha M,Boehm H,et al.Adjacent segment disease after cervical spine fusion:evaluation of a 70 patient long-term follow-up[J].Spine(Phila Pa1976),2018,43(9):605-609.
[11]Park MS,Kelly MP,Lee DH,et al.Sagittal alignment as a predictor of clinical adjacent segment pathology requiring surgery after anterior cervical arthrodesis[J].Spine J,2013,14(7):1228-1234.
[12]Bin S,Xiangwang H,Sheng X,et al.Artificial cervical disk replacement for the treatment of adjacent segment disease after anterior cervical decompression and fusion[J].Clin Spine Surg,2017,30(5):E587-E591.
[13]O’Neill KR,Wilson RJ,Burns KM,et al.Anterior cervical discectomy and fusion for adjacent segment disease:clinical outcomes and cost utility of surgical intervention[J].Clin Spine Surg,2016,29(6):234-241.
[14]Wang F,Wang P,Miao DC,et al.Different surgical approaches for the treatment of adjacent segment diseases after anterior cervical fusion:a retrospective study of 49patients[J].Medicine(Baltimore),2017,96(23):e7042.
[15]王洪立,姜建元,吕飞舟,等.颈椎前路融合术后邻近节段退变性疾病的原因分析及治疗策略[J].中华骨科杂志,2014,34(9):915-922.
[16]Ahn SS,Paik HK,Chin DK,et al.The fate of adjacent segments after anterior cervical discectomy and fusion:the influence of an anterior plate system[J].World Neurosurg,2016,89:42-50.
[17]Helgeson MD,Bevevino AJ,Hilibrand AS.Update on the evidence for adjacent segment degeneration and disease[J].Spine J,2013,13(3):342-351.