[1]许世林,白贵文,薛东鹤,等.颈前路零切迹椎间融合器治疗邻近双节段脊髓型颈椎病的疗效分析[J].医学信息,2023,36(16):98-103.[doi:10.3969/j.issn.1006-1959.2023.16.018]
　XU Shi-lin,BAI Gui-wen,XUE Dong-he,et al.Clinical Analysis of Anterior Cervical Interbody Fusion with Zero-P in the Treatment of Adjacent Two-level Cervical Spondylotic Myelopathy[J].Journal of Medical Information,2023,36(16):98-103.[doi:10.3969/j.issn.1006-1959.2023.16.018]
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颈前路零切迹椎间融合器治疗邻近双节段脊髓型颈椎病的疗效分析()
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医学信息[ISSN:1006-1959/CN:61-1278/R]

卷:
36卷
期数:
2023年16期
页码:
98-103
栏目:
论著
出版日期:
2023-08-15

文章信息/Info

Title:
Clinical Analysis of Anterior Cervical Interbody Fusion with Zero-P in the Treatment of Adjacent Two-level Cervical Spondylotic Myelopathy
文章编号:
1006-1959（2023）16-0098-06
作者:
许世林; 白贵文; 薛东鹤; 等
（郑州大学第二附属医院骨科一病区，河南 郑州 450000）
Author(s):
XU Shi-lin; BAI Gui-wen; XUE Dong-he; et al.
(The First Ward of Orthopedics Department,the Second Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,Henan,China)
关键词:
脊髓型颈椎病; 颈椎前路零切迹椎间融合器; 腰椎功能
Keywords:
Cervical myelopathy; Anterior cervical interbody fusion with Zero-P; Lumbar function
分类号:
R651.2
DOI:
10.3969/j.issn.1006-1959.2023.16.018
文献标志码:
A
摘要:
目的 探讨颈椎前路零切迹椎间融合器治疗邻近双节段脊髓型颈椎病的临床疗效。方法 选取2018年12月-2020年1月我院行手术治疗的双节段脊髓型颈椎病患者80例作为研究对象，根据治疗方案不同分为对照组（n=38）和观察组（n=42）。观察组予以颈椎前路零切迹椎间融合器治疗，对照组予以钛板内固定椎间融合器治疗，比较两组手术情况、疼痛情况、腰椎功能及影像学指标。结果 观察组手术时间短于对照组，术中出血量、透视次数、术后引流量少于对照组，差异有统计学意义（P＜0.05）；两组术后3、6、12个月JOA评分、VAS评分优于术前，差异有统计学意义（P＜0.05），而两组术后各随访时间点JOA评分、VAS评分比较，差异无统计学意义（P＞0.05）。观察组吞咽困难占比低于对照组，差异有统计学意义（P＜0.05）；两组术后3、6、12个月Cobb角、C2~7颈椎曲度和椎间隙高度优于术前，差异有统计学意义（P＜0.05），但两组各个随访时间点C2~7颈椎曲度及椎间融合率比较，差异无统计学意义（P＞0.05）；术后12个月，两组手术病变节段均达到骨性融合，椎间融合率均为100.00%，且观察组与对照组Cobb角及椎间隙高度比较，差异有统计学意义（P＜0.05）。结论 两组术式均能重建良好的颈椎曲度和椎间隙高度，神经功能恢复较好，但零切迹椎间融合术较钛板椎间融合术比手术时间短、术中出血量少及透视次数减少，且术后吞咽困难发生率低，安全性能更好。
Abstract:
Objective To investigate the clinical efficacy of anterior cervical interbody fusion with Zero-P in the treatment of adjacent two-level cervical spondylotic myelopathy.Methods A total of 80 patients with two-level cervical spondylotic myelopathy who underwent surgical treatment in our hospital from December 2018 to January 2020 were selected as the research objects. According to different treatment schemes, they were divided into control group (n=38) and observation group (n=42). The observation group was treated with anterior cervical interbody fusion with Zero-P, and the control group was treated with titanium plate internal fixation interbody fusion cage. The operation, pain, lumbar function and imaging indexes of the two groups were compared.Results The operation time of the observation group was shorter than that of the control group, and the intraoperative blood loss, fluoroscopy times and postoperative drainage volume were less than those of the control group, the differences were statistically significant (P<0.05). The JOA score and VAS score of the two groups at 3, 6 and 12 months after operation were better than those before operation, and the difference was statistically significant (P<0.05), while there was no significant difference in JOA score and VAS score between the two groups at each follow-up time point after operation (P>0.05). The proportion of dysphagia in the observation group was lower than that in the control group, the difference was statistically significant (P<0.05). The Cobb angle, C2-7 cervical curvature and intervertebral space height of the two groups at 3, 6 and 12 months after operation were better than those before operation, and the differences were statistically significant (P<0.05), however, there was no significant difference in C2-7 cervical curvature and intervertebral fusion rate between the two groups at each follow-up time point (P>0.05). At 12 months after operation, the surgical lesion segments of both groups achieved bony fusion, and the intervertebral fusion rate was 100.00%. There were statistically significant differences in Cobb angle and intervertebral space height between observation group and control group (P<0.05).Conclusion Both groups can reconstruct good cervical curvature and intervertebral space height, and the recovery of neurological function is better. However, compared with titanium plate interbody fusion, zero notch interbody fusion has shorter operation time, less intraoperative blood loss and less fluoroscopy times, and the incidence of postoperative dysphagia is lower and the safety performance is better.

参考文献/References:

[1]McCormick JR,Sama AJ,Schiller NC,et al.Cervical Spondylotic Myelopathy: A Guide to Diagnosis and Management[J].J Am Board Fam Med,2020,33(2):303-313.[2]Wen Z,Lu T,Wang Y,et al.Anterior Cervical Corpectomy and Fusion and Anterior Cervical Discectomy and Fusion Using Titanium Mesh Cages for Treatment of Degenerative Cervical Pathologies: A Literature Review[J].Med Sci Monit,2018,24:6398-6404.[3]Carrier CS,Bono CM,Lebl DR.Evidence-based analysis of adjacent segment degeneration and disease after ACDF: a systematic review[J].Spine J,2013,13(10):1370-1378.[4]余伟宏,卢国樑,冯永洪,等.零切迹颈椎前路椎间融合固定系统治疗单节段颈椎间盘突出症的效果[J].实用临床医学,2018,19(6):40-41.[5]Bazaz R,Lee MJ,Yoo JU.Incidence of dysphagia after anterior cervical spine surgery: a prospective study[J].Spine,2002;27(22):2453-2458. [6]Liu Y,Hou Y,Yang L,et al.Comparison of 3 reconstructive techniques in the surgical management of multilevel cervical spondylotic myelopathy[J].Spine (Phila Pa 1976),2012,37(23):E1450-E1458.[7]Goel A,Shah A,Patni N,et al.Immediate postoperative reversal of disc herniation following facetal distraction-fixation surgery: report of four cases[J].World Neurosurg,2016,94(12):339-344.[8]Wang BY,Wu TK,Liu H,et al.Intraoperative conversion of artificial cervical disc replacement to anterior cervical discectomy and fusion for iatrogenic fracture: A rare case report[J].Medicine,2017,96(47):e8917.[9]Zhao B,Qiu X,Wang D,et al.Application of bioabsorbable screw fixation for anterior cervical decompression and bone grafting[J].Clinics(Sao Paulo),2016,71(6):320-324.[10]Xiao S,Liang Z,Wei W,et al.Zero-profile anchored cage reduces risk of postoperative dysphagia compared with cage with plate fixation after anterior cervical discectomy and fusion[J].Eur Spine J,2017,26(4):975-984.[11]Chang H,Baek DH,Choi BW.Efficacy of Zero-Profile implant inanterior fusion to treat degenerative cervical spine disease:comparison with techniques using bone graft and anterior plating[J].J Neurol Surg A Cent Eur Neurosurg,2015,76(4):268-273.[12]蒋俊锋,蒋建刚,蒋建农.颈前路多节段单间隙固定和椎体次全切钛网固定治疗多节段脊髓型颈椎病临床疗效对比[J].中国临床医生杂志,2017,45(8):65-67.[13]Scholz M,Schnake KJ,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.[14]高小亮,杨晓辉,黄卫民,等.颈前路零切迹椎间融合内固定系统治疗脊髓型颈椎病的效果及安全性分析[J].国际骨科学杂志,2017,38(3):192-196.[15]Song KJ,Choi BW,Kim JK.Adjcentsement pathology following anterior decompression and fusion using cage and plate for the treatment of degenerative cervical spinal diseases[J].Asian Spine J,2014,8(6):720-728.[16]Yang H,Chen D,Wang X,et al.Zero-profile integrated plate and spacer device reduces rate of adjacent-level ossification development and dysphagia compared to ACDF with plating and cage system[J].Arch Orthop Trauma Surg,2015,135(6):781-787.[17]郭龙,范顺武.零切迹颈前路椎间融合系统与颈前路钢板椎间融合系统临床疗效比较[J].中国修复重建外科杂志,2015,29(7):840-844.[18]刘俊良,镇万新,高国勇,等.前路减压联合零切迹椎间融合固定系统治疗脊髓型颈椎病疗效分析[J].新乡医学院学报,2014,31(5):371-373.[19]杨俊松,刘鹏,刘团江,等.零切迹椎间融合器与钛板-椎间融合器系统对颈前路术后C2~C7颈椎曲度维持的临床研究[J].中国修复重建外科志,2020,34(2):151-156.[20]Chen Y,Lü 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[J].Eur Spine J,2016,25(7):2255-2262.[21]Park JY,Choi KY,Moon BJ,et al.Subsidence after single-level anterior cervical fusion with a stand-alone Cage[J].J Clin Neurosci,2016,33:83-88.

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更新日期/Last Update: 1900-01-01