颈前路零切迹椎间融合与钛板融合器内固定治疗颈椎间盘突出症的影像学评价
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摘要
背景:颈前路椎间盘切除减压植骨融合治疗颈椎间盘突出症的效果显著,但有颈椎不稳、融合率低等缺点,钛板融合器可以弥补这些缺点,但仍有一些常见并发症发生。一种新型的同时具有支持和固定椎体的一体式颈前路零切迹(Zero-P)椎间融合器在临床广泛应用。目的:对比颈前路零切迹椎间融合内固定与钛板融合器内固定治疗颈椎间盘突出症的临床效果。方法:回顾性分析2016年1月至2017年6月在佛山市禅城区中心医院接受治疗的42例单节段颈椎病患者的临床资料,根据手术方式分为2组,其中颈前路零切迹椎间融合内固定治疗组(Zero-P组)21例,颈前路钛板融合器内固定治疗组(钛板组)21例。比较2组患者的手术时间、术中出血量、日本骨科学会评分及其改善率、吞咽困难程度、Cobb角、融合节段椎体间高度及其增加率。结果与结论:①Zero-P组术中出血量与钛板组相比差异无显著性意义(P>0.05),但Zero-P组手术时间明显短于钛板组(P <0.05);②术后3,6,18个月时2组的JOA评分均较术前显著增加(P <0.05),但在相同随访时间2组的日本骨科学会评分及其改善率相比差异无显著性意义(P> 0.05);③术后6个月钛板组有2例(10%)发生轻度吞咽困难,而Zero-P组吞咽困难症状消失;术后18个月钛板组仍有1例(5%)发生轻度吞咽困难;④Zero-P组Cobb角术后3,6,18个月与钛板组相比差异有显著性意义(P <0.05);⑤2组椎体间高度增加率术后3个月相比差异无显著性意义(P> 0.05),而术后6,18个月Zero-P组椎体间高度增加率显著高于钛板组(P <0.05);⑥提示对颈椎间盘突出症患者实施颈前路零切迹椎间融合内固定与钛板融合器内固定治疗均可以取得良好的效果;但零切迹椎间融合内固定更有利于维持颈椎曲度及椎体间高度,并降低术后吞咽难的发生率,因此更具优势。
BACKGROUND: Anterior cervical discectomy and decompression, and fusion for treating cervical disc herniation have significant effects, but there are shortcomings such as cervical instability and low fusion rate. Titanium plate with cage interbody fixation and fusion system can make up for these shortcomings, but there are still some common complications. A new Zero-P interbody fixation and fusion system with support and fixation function is widely used in clinical practice.OBJECTIVE: To compare the clinical effect of a new Zero-P interbody fixation and fusion system and titanium plate with cage interbody fixation and fusion system for treating cervical disc herniation.METHODS: Clinical data of 42 patients with single-segment cervical spondylosis admitted at Foshan Chancheng Central Hospital from January 2016 to June 2017 were analyzed retrospectively. According to the surgical method, 21 cases were treated with Zero-P interbody fixation and fusion system(Zero-P group) and 21 cases with titanium plate with cage interbody fixation and fusion system(titanium plate group). The operation time, intraoperative blood loss, Japanese Orthopaedic Association score and improvement rate, dysphagia,Cobb angle, and height and increase rate of the fused segment were compared between two groups.RESULTS AND CONCLUSION:(1) There was no significant difference in the intraoperative blood loss between two groups(P > 0.05), and the operation time in the Zero-P group was significantly shorter than that in the titanium plate group(P < 0.05).(2) The Japanese Orthopaedic Association scores in the two groups were significantly increased at 3, 6 and 18 months postoperatively(P < 0.05), and no significant difference was found in the scores and score improvement rate between two groups at the same follow-up time(P > 0.05).(3) Two patients(10%) in the titanium plate group developed mild dysphagia at 6 months after surgery, while the symptoms of dysphagia in the Zero-P group disappeared. There was still one case(5%) of mild dysphagia in the titanium plate group at postoperative 18 months.(4) The Cobb angle in the Zero-P group was significantly different from the titanium plate group at 3, 6 and 18 months postoperatively(P < 0.05).(5) There was no significant difference in the rate of height increase between two groups at 3 months postoperatively(P > 0.05). There was a significant difference in the rate of intervertebral height between two groups postoperative at postoperative 6 and 18 months(P < 0.05).(6) To conclude,Zero-P interbody fixation and fusion system and titanium plate with cage interbody fixation and fusion system for treating cervical disc herniation both can achieve good results. However, Zero-P interbody fixation and fusion system is more conducive to maintaining cervical curvature and intervertebral height, and reducing the incidence of postoperative dysphagia.
BACKGROUND: Anterior cervical discectomy and decompression, and fusion for treating cervical disc herniation have significant effects, but there are shortcomings such as cervical instability and low fusion rate. Titanium plate with cage interbody fixation and fusion system can make up for these shortcomings, but there are still some common complications. A new Zero-P interbody fixation and fusion system with support and fixation function is widely used in clinical practice.OBJECTIVE: To compare the clinical effect of a new Zero-P interbody fixation and fusion system and titanium plate with cage interbody fixation and fusion system for treating cervical disc herniation.METHODS: Clinical data of 42 patients with single-segment cervical spondylosis admitted at Foshan Chancheng Central Hospital from January 2016 to June 2017 were analyzed retrospectively. According to the surgical method, 21 cases were treated with Zero-P interbody fixation and fusion system(Zero-P group) and 21 cases with titanium plate with cage interbody fixation and fusion system(titanium plate group). The operation time, intraoperative blood loss, Japanese Orthopaedic Association score and improvement rate, dysphagia,Cobb angle, and height and increase rate of the fused segment were compared between two groups.RESULTS AND CONCLUSION:(1) There was no significant difference in the intraoperative blood loss between two groups(P > 0.05), and the operation time in the Zero-P group was significantly shorter than that in the titanium plate group(P < 0.05).(2) The Japanese Orthopaedic Association scores in the two groups were significantly increased at 3, 6 and 18 months postoperatively(P < 0.05), and no significant difference was found in the scores and score improvement rate between two groups at the same follow-up time(P > 0.05).(3) Two patients(10%) in the titanium plate group developed mild dysphagia at 6 months after surgery, while the symptoms of dysphagia in the Zero-P group disappeared. There was still one case(5%) of mild dysphagia in the titanium plate group at postoperative 18 months.(4) The Cobb angle in the Zero-P group was significantly different from the titanium plate group at 3, 6 and 18 months postoperatively(P < 0.05).(5) There was no significant difference in the rate of height increase between two groups at 3 months postoperatively(P > 0.05). There was a significant difference in the rate of intervertebral height between two groups postoperative at postoperative 6 and 18 months(P < 0.05).(6) To conclude,Zero-P interbody fixation and fusion system and titanium plate with cage interbody fixation and fusion system for treating cervical disc herniation both can achieve good results. However, Zero-P interbody fixation and fusion system is more conducive to maintaining cervical curvature and intervertebral height, and reducing the incidence of postoperative dysphagia.
引文
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[6]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.
[7]Zhang J,Meng F,Yan D,et al.Hybrid surgery versus anterior cervical discectomy and fusion in multilevel cervical disc diseases:a meta-analysis.Medicine.2016;95(21):e3621.
[8]Ament JD,Yang Z,Pierce N,et al.Cost utility analysis of the cervical artificial disc vs fusion for the treatment of 2-level symptomatic degenerative disc disease:5-year follow-up.Neurosurgery.2016;79(1):135-145.
[9]Hou Y,Nie L,Pan X,et al.Effectiveness and safety of Mobi-C for treatment of single-level cervical disc spondylosis:a randomised control trial with a minimum of five years of follow-up.Bone Joint J.2016;98-B(6):829.
[10]Hori M,Tsutsumi S,Yasumoto Y,et al.Cervical spondylosis:evaluation of microstructural changes in spinal cord white matter and gray matter by diffusional kurtosis imaging.Magn Reson Imaging.2014;32(5):428-432.
[11]Yang JS,Chu L,Chen L,et al.Anterior or posterior approach of full-endoscopic cervical discectomy for cervical intervertebral disc herniation?A comparative cohort study.Spine.2014;39(21):1743-1750.
[12]刘威,盛伟斌,张健,等.颈椎间盘置换及前路椎间融合治疗单节段颈椎间盘突出症:谁更多影响邻近节段发生退变[J].中国组织工程研究,2016,20(4):504-510.
[13]文天林,孙天胜.脊髓型颈椎病的病理演变和治疗研究进展[J].人民军医,2017,11(1):75-76.
[14]Hou Y,Nie L,Pan X,et al.Effectiveness and safety of Mobi-C for treatment of single-level cervical disc spondylosis:a randomised control trial with a minimum of five years of follow-up.Bone Joint J.2016;98-B(6):829.
[15]Lin SY,Chen DC,Lin CL,et al.Risk of acute coronary syndrome in patients with cervical spondylosis.Atherosclerosis.2018;271(35):136-141.
[16]金成春,鲍广全,徐宏光.颈前路减压椎间融合器植骨融合术治疗单节段脊髓型颈椎病临床观察[J].山东医药,2017,57(16):64-66.
[17]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,2018,26(5):154-155.
[18]Miao Q,Qiang JH,Jin YL.Effectiveness of percutaneous neuromuscular electrical stimulation for neck pain relief in patients with cervical spondylosis.Medicine.2018;97(26):e11080.
[19]Liu B,Zhu D,Yang J,et al.Can Multilevel Anterior Cervical Discectomy and Fusion Result in Decreased Lifting Capacity of the Shoulder?World Neurosurg.2015;84(6):1636-1644.
[20]徐远金,杨俊峰.前路减压植骨融合联合钢板置入内固定治疗脊髓型颈椎病的效果分析[J].颈腰痛杂志,2017,9(6):598-599.
[21]王宁,何百祥,鲍刚,等.颈前路“零切迹”椎间融合器与传统钛板融合器内固定治疗单节段颈椎病的疗效比较[J].西安交通大学学报(医学版),2016,11(2):174-177.
[22]孙柏寒,郑柏,黄栋,等.零切迹颈椎融合器ROI-C与传统钢板内固定治疗颈椎病临床效果比较[J].中国医药导报,2017,14(6):100-103.
[23]庄超,周栋,汤雪明,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疗效分析[J].中国修复重建外科杂志,2015,17(6):751-755.
[24]刘春雷,王建伟,郭安丰,等.Zero-P颈椎前路椎间融合固定系统在颈椎前路减压融合术中的效果观察[J].实用中西医结合临床,2018,17(2):503-504.
[25]张圣飞,冯新民,张亮,等.颈椎Zero-P融合器与传统钛板融合内固定治疗双节段颈椎病的疗效比较[J].中华临床医师杂志(电子版),2015,9(11):2107-2112.
[26]季海龙,赵秀泉,张丽,等.零切迹椎间融合器(Zero-P)治疗老年单节段脊髓型颈椎病的效果分析[J].川北医学院学报,2017,32(4):504-506.
[27]周锋,传礼,世卿.应用Zero-P行颈前路椎间融合术治疗外伤性颈椎椎间盘突出并脊髓损伤[J].脊柱外科杂志,2017,15(6):344-347.
[28]许艺荠,张雪松,孙太存,等.新型Zero-P与cage钛板椎间融合器修复颈椎病:早期稳定性对比[J].中国组织工程研究,2016,20(22):3227-3234.
[29]Barbagallo GM,Romano D,Certo F,et al.Zero-P:a new zero-profile cage-plate device for single and multilevel ACDF.Asingle Institution series with four years maximum follow-up and review of the literature on zero-profile devices.Eur Spine J.2013;22(6):S868-S878.
[30]吴增志,赖茂松,熊浩,等.Zero-P椎间融合术治疗颈椎间盘突出并脊髓损伤的疗效观察[J].实用骨科杂志,2017,23(4):363-365.
[2]Goel A,Shah A,Patni N,et al.Immediate postoperative reversal of disc herniation following facetal distraction-fixation surgery:report of four cases.World Neurosurg.2016;94(12):339-344.
[3]Kawasaki T,Fukuda H,Kurosaki Y,et al.Acute compressive myelopathy caused by spinal subarachnoid hemorrhage:a combined effect of asymptomatic cervical spondylosis.World Neurosurg.2016;95(7):619.e1-619.e4.
[4]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.Medicine.2017;96(47):e8917.
[5]胡迪,王少飞,晁建虎,等.2种颈前路椎间融合内固定治疗单节段颈椎间盘突出症的疗效比较[J].中国骨与关节损伤杂志,2015,30(3):295-296.
[6]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.
[7]Zhang J,Meng F,Yan D,et al.Hybrid surgery versus anterior cervical discectomy and fusion in multilevel cervical disc diseases:a meta-analysis.Medicine.2016;95(21):e3621.
[8]Ament JD,Yang Z,Pierce N,et al.Cost utility analysis of the cervical artificial disc vs fusion for the treatment of 2-level symptomatic degenerative disc disease:5-year follow-up.Neurosurgery.2016;79(1):135-145.
[9]Hou Y,Nie L,Pan X,et al.Effectiveness and safety of Mobi-C for treatment of single-level cervical disc spondylosis:a randomised control trial with a minimum of five years of follow-up.Bone Joint J.2016;98-B(6):829.
[10]Hori M,Tsutsumi S,Yasumoto Y,et al.Cervical spondylosis:evaluation of microstructural changes in spinal cord white matter and gray matter by diffusional kurtosis imaging.Magn Reson Imaging.2014;32(5):428-432.
[11]Yang JS,Chu L,Chen L,et al.Anterior or posterior approach of full-endoscopic cervical discectomy for cervical intervertebral disc herniation?A comparative cohort study.Spine.2014;39(21):1743-1750.
[12]刘威,盛伟斌,张健,等.颈椎间盘置换及前路椎间融合治疗单节段颈椎间盘突出症:谁更多影响邻近节段发生退变[J].中国组织工程研究,2016,20(4):504-510.
[13]文天林,孙天胜.脊髓型颈椎病的病理演变和治疗研究进展[J].人民军医,2017,11(1):75-76.
[14]Hou Y,Nie L,Pan X,et al.Effectiveness and safety of Mobi-C for treatment of single-level cervical disc spondylosis:a randomised control trial with a minimum of five years of follow-up.Bone Joint J.2016;98-B(6):829.
[15]Lin SY,Chen DC,Lin CL,et al.Risk of acute coronary syndrome in patients with cervical spondylosis.Atherosclerosis.2018;271(35):136-141.
[16]金成春,鲍广全,徐宏光.颈前路减压椎间融合器植骨融合术治疗单节段脊髓型颈椎病临床观察[J].山东医药,2017,57(16):64-66.
[17]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,2018,26(5):154-155.
[18]Miao Q,Qiang JH,Jin YL.Effectiveness of percutaneous neuromuscular electrical stimulation for neck pain relief in patients with cervical spondylosis.Medicine.2018;97(26):e11080.
[19]Liu B,Zhu D,Yang J,et al.Can Multilevel Anterior Cervical Discectomy and Fusion Result in Decreased Lifting Capacity of the Shoulder?World Neurosurg.2015;84(6):1636-1644.
[20]徐远金,杨俊峰.前路减压植骨融合联合钢板置入内固定治疗脊髓型颈椎病的效果分析[J].颈腰痛杂志,2017,9(6):598-599.
[21]王宁,何百祥,鲍刚,等.颈前路“零切迹”椎间融合器与传统钛板融合器内固定治疗单节段颈椎病的疗效比较[J].西安交通大学学报(医学版),2016,11(2):174-177.
[22]孙柏寒,郑柏,黄栋,等.零切迹颈椎融合器ROI-C与传统钢板内固定治疗颈椎病临床效果比较[J].中国医药导报,2017,14(6):100-103.
[23]庄超,周栋,汤雪明,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疗效分析[J].中国修复重建外科杂志,2015,17(6):751-755.
[24]刘春雷,王建伟,郭安丰,等.Zero-P颈椎前路椎间融合固定系统在颈椎前路减压融合术中的效果观察[J].实用中西医结合临床,2018,17(2):503-504.
[25]张圣飞,冯新民,张亮,等.颈椎Zero-P融合器与传统钛板融合内固定治疗双节段颈椎病的疗效比较[J].中华临床医师杂志(电子版),2015,9(11):2107-2112.
[26]季海龙,赵秀泉,张丽,等.零切迹椎间融合器(Zero-P)治疗老年单节段脊髓型颈椎病的效果分析[J].川北医学院学报,2017,32(4):504-506.
[27]周锋,传礼,世卿.应用Zero-P行颈前路椎间融合术治疗外伤性颈椎椎间盘突出并脊髓损伤[J].脊柱外科杂志,2017,15(6):344-347.
[28]许艺荠,张雪松,孙太存,等.新型Zero-P与cage钛板椎间融合器修复颈椎病:早期稳定性对比[J].中国组织工程研究,2016,20(22):3227-3234.
[29]Barbagallo GM,Romano D,Certo F,et al.Zero-P:a new zero-profile cage-plate device for single and multilevel ACDF.Asingle Institution series with four years maximum follow-up and review of the literature on zero-profile devices.Eur Spine J.2013;22(6):S868-S878.
[30]吴增志,赖茂松,熊浩,等.Zero-P椎间融合术治疗颈椎间盘突出并脊髓损伤的疗效观察[J].实用骨科杂志,2017,23(4):363-365.
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