中国组织工程研究

中国组织工程研究 ›› 2014, Vol. 18 ›› Issue (22): 3487-3492.doi: 10.3969/j.issn.2095-4344.2014.22.008

• 脊柱植入物 spinal implant • 上一篇    下一篇

零切迹颈前路椎间融合系统治疗颈椎病：支撑固定效果近期评价

尹 飚，唐 龙，章 波，王 簕，丁 强，张 亮，张 志，杨 波   

  1. 广州医科大学附属第三医院骨科，广东省广州市 510150
  • 修回日期:2014-03-31 出版日期:2014-05-28 发布日期:2014-05-28
  • 通讯作者: 杨波，副主任，教授，硕士生导师，广州医科大学附属第三医院骨科，广东省广州市 510150
  • 作者简介:尹飚，男，1971年生，江西省吉安市人，汉族，2000年解放军第一军医大学毕业，硕士，副主任医师，主要从事脊柱与关节方面的研究。
  • 基金资助:

    2013年广州市科技计划项目(2013J4100101)；2013年广东省自然科学基金资助项目(S2013010011532)

Zero-profile anterior cervical interbody fusion for cervical spondylosis: short-period evaluation of support and fixation outcomes

Yin Biao, Tang Long, Zhang Bo, Wang Le, Ding Qiang, Zhang Liang, Zhang Zhi, Yang Bo   

  1. Department of Orthopedics, Third Affiliated Hospital, Guangzhou Medical University, Guangzhou 510150, Guangdong Province, China
  • Revised:2014-03-31 Online:2014-05-28 Published:2014-05-28
  • Contact: Yang Bo, Professor, Master’s supervisor, Department of Orthopedics, Third Affiliated Hospital, Guangzhou Medical University, Guangzhou 510150, Guangdong Province, China
  • About author:Yin Biao, Master, Associate chief physician, Department of Orthopedics, Third Affiliated Hospital, Guangzhou Medical University, Guangzhou 510150, Guangdong Province, China
  • Supported by:

    spinal fusion|cervical vertebrae|internal fixators|deglutition disorders

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摘要：

背景：颈前路椎间盘切除减压融合治疗颈椎病的疗效确切，但存在一些诸如吞咽困难、食管瘘等并发症。一种新型具备支撑、融合及固定功能的一体式颈前路椎间融合系统在2008年研制成功并投入临床使用。

目的：观察颈前路融合过程中应用零切迹颈前路椎间融合内固定系统治疗颈椎病的近期临床疗效。
方法：纳入颈前路椎间盘切除减压联合零切迹颈前路椎间融合内固定系统治疗颈椎病患者20例(21节段)。应用目测类比评分及日本骨科学会17分法对患者疼痛改善及神经功能情况进行评估，计算随访终末日本骨科学会17分法评分优良率。参考Bazaz吞咽困难评价标准评估患者治疗后吞咽困难症状，统计吞咽困难发生率。对比治疗前后颈椎正侧位X射线片，通过椎间隙高度恢复情况、椎间融合程度及内固定相关并发症评估近期临床疗效。

结果与结论：手术时间70-170 min，平均时间93.4 min；术中出血量20-260 mL，平均107.6 mL，住院时间4-9 d，平均5.3 d。所有患者获得随访，时间为13-20个月。治疗后2 d、治疗后1个月及随访终末，目测类比评分较治疗前显著降低(P < 0.05-0.01)，日本骨科学会17分法评分较治疗前显著提高(P < 0.01)；随访终末日本骨科学会17分法评分优良率为95%(19/20)。2例患者治疗后1周内出现吞咽不适，1例为轻度，1例为中度，行对症治疗，1例治疗后2周内症状消失，1例治疗后2个月内消失。颈椎正侧位X射线片检查结果显示，随访终末椎间隙高度较治疗前有一定程度恢复，椎间融合率95%(19/20)，未发现椎间融合器及内固定螺钉松动、断裂、移位等并发症。提示颈前路零切迹颈前路椎间融合内固定系统置入治疗颈椎病操作简便，对颈前组织损伤小，可明显缓解疼痛及改善神经功能，具有良好的支撑、固定及融合效果，能一定程度恢复椎间高度，治疗后并发症罕见，近期临床疗效满意。


中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程


全文链接：

关键词: 植入物, 脊柱植入物, 零切迹颈前路椎间融合内固定, 颈椎病, 近期疗效, 广东省自然科学基金

Abstract:

BACKGROUND: The anterior cervical discectomy and fusion has a curative effect in treatment of cervical spondylosis, but has such complications as dysphagia and esophagostoma. A new anterior cervical interbody fusion, with support, fusion and fixation function, was researched successfully and applied to clinical treatment in 2008.

OBJECTIVE: To analyze the short-period clinical outcome of the zero-profile anterior cervical interbody fusion for cervical spondylosis.
METHODS: A total of 20 patients (21 segments) undergoing anterior cervical discectomy and zero-profile anterior cervical interbody fusion were enrolled in this study. Visual analogue scale and Japanese Orthopaedic Association were used to evaluate the improvement of ache and neurological function. The excellent and good  rate of Japanese Orthopaedic Association was calculated in the final follow-up. Bazaz standards were utilized to assess the symptom of dysphagia after operation. The incidence of dysphagia was recorded. Anteroposterior and lateral radiographs were compared before and after treatment. Short-period clinical outcomes were evaluated using the recovery of intervertebral height, fusion condition and fixation-associated complications.
RESULTS AND CONCLUSION: The operation time was between 70 and 170 minutes (averagely 93.4 minutes), blood loss was between 20 and 260 mL (averagely 107.6 mL) and length of stay was between 4 to 9 days (averagely 5.3 days). All patients were followed up for 13 to 20 months. Visual analogue scale scores were significantly lower at 2 days and 1 month posttreatment and final follow-up compared with preoperation (P < 0.05-0.01). Japanese Orthopaedic Association scores were significantly higher at 2 days and 1 month posttreatment and final follow-up compared with preoperation
(P < 0.01). The excellent and good rate of Japanese Orthopaedic Association was 95% (19/20) in final follow-up. Among two patients who had dysphagia within 1 week after operation, one was mild and the other was moderate. Symptomatic treatment was conducted. The symptom disappeared in one case within 2 weeks after treatment and in one case within 2 months after treatment. Anteroposterior and lateral radiographs revealed that the intervertebral height obtained a certain increase and achieved bone fusion 95% (19/20) at final follow-up. There were no complications such as fixator loosening, breakage and shifting. Results suggested that zero-profile anterior cervical interbody fusion for cervical spondylosis is simple to operate, has small trauma on cervical tissues, can obviously lessen pain, improve neurological function, has good support fixation and fusion functions, and can effectively recover intervertebral height. Postoperative complications are rare. Short-period clinical results are satisfactory.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程


全文链接：

Key words: spinal fusion, cervical vertebrae, internal fixators, deglutition disorders

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