| 沙卫平,陈国兆,王黎明.零切迹双插片自稳型颈椎融合器与锁定钛板内固定治疗单节段颈椎病的短期临床疗效比较.骨科,2021,12(5): 414-420. |
| 零切迹双插片自稳型颈椎融合器与锁定钛板内固定治疗单节段颈椎病的短期临床疗效比较 |
| Short-Term Clinical Effect of Double Bladed Zero-Profile Anchoredspacer and Locking Plate in the Treatment of Single Segmental Ceivical Spondylosis |
| 投稿时间：2021-02-28 |
| DOI：10.3969/j.issn.1674-8573.2021.05.005 |
| 中文关键词: ROI-C融合器 锁定钛板 单节段颈椎病 颈椎前路手术 短期临床疗效 |
| 英文关键词: Double bladed zero-profile anchoredspacer fusion cage Locking plate Single segment cervical spondylosis Anterior cervical surgery Short term clinical effect |
| 基金项目:2018年度苏州市科技发展计划（SYSD2018006） |
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| 中文摘要: |
| 目的 比较零切迹双插片自稳型颈椎融合器（ROI-C）与锁定钛板内固定治疗单节段颈椎病的短期临床疗效。方法 运用回顾性研究方法，选择2017年1月至2019年12月我院收治的61例明确诊断为单节段颈椎病的病人，行颈椎前路减压融合内固定术（anterior cervical decompression and fusion，ACDF）治疗。采用ROI-C固定的30例纳入ROI-C组，其中C3/4退变8例，C4/5退变10例，C5/6退变12例。行常规锁定钛板内固定术治疗的31例纳入钛板组，其中C3/4退变7例，C4/5退变11例，C5/6退变13例。比较两组病人的术中出血量、手术时间，术前和术后1、6、12个月时上肢的疼痛视觉模拟量表（visual analogue scale，VAS）评分、日本骨科学会（Japanese Orthopaedic Association，JOA）评分、颈椎融合节段高度、颈椎矢状位Cobb角，并以Bazaz评分系统评估两组病人术后是否存在吞咽困难情况以及严重程度。结果 61例病人随访12~15个月，平均13.5个月。术中术后未见切口感染、食管破裂、大血管损伤、喉上神经损伤、喉返神经损伤、腺体损伤、脑脊液漏、内固定感染、内固定松动移位等并发症发生。ROI-C组、钛板组的手术时间分别为（81.33±10.74） min、（93.67±11.59） min，术中出血量分别为（77.33±22.43） mL、（108.33±24.08） mL，两组比较，差异均有统计学意义（P＜0.05）。两组术后不同随访时间点的VAS评分、JOA评分较术前均改善明显，差异有统计学意义（P＜0.05），但组间比较，差异无统计学意义（P＞0.05）。ROI-C组和钛板组术后不同随访时间点的Cobb角比较，差异有统计学意义（P＜0.05）；但颈椎融合节段高度的组间比较，差异无统计学意义（P＞0.05）。ROI-C组和钛板组术后吞咽不适的发生率分别为6.67%（2/30）、35.48%（11/31），组间差异有统计学意义（χ2=7.550，P=0.005）。吞咽不适病人均未予特殊处理，术后随访过程中病人吞咽不适感逐渐消失。末次随访所有病人均获得骨性融合。结论 ROI-C与锁定钛板内固定治疗单节段退变性颈椎病均可取得良好的临床疗效，但应用ROI-C手术时间短、术中出血少、术后吞咽不适情况发生率低且颈椎生理曲度不易丢失，值得临床推广。 |
| 英文摘要: |
| Objective To compare the short-term clinical effect of double bladed zero-profile anchoredspacer (ROI-C) vs. locking plate in the treatment of single segmental ceivical spondylosis. Methods By the retrospective study, 61 cases of single segmental ceivical spondylosis were treated by anterior cervical decompression and fusion from January 2017 to December 2019. A total of 30 cases were treated with ROI-C fixation including C3/4 in 8 cases, C4/5 in 10 cases, C5/6 in 12 cases, and 31 cases were treated with locking plate fixation including C3/4 in 7 cases, C4/5 in 11 cases, C5/6 in 13 cases. The operation time and operative bleeding were observed. Visual analogue scale (VAS), Japanese Orthopaedic Association (JOA) scores were used to evaluate the pre- and post-operative outcome of the pain and quality of the patients; imaging X-ray was used to evaluate the fusion segment height and cervival sagittal Cobb angle; Bazaz scoring system was used to evaluate the presence and severity of dysphagia. Results All 61 patients were followed up for 12-15 months, with an average of 13.5 months. No complications such as incision infection, esophageal rupture, large blood vessel injury, superior laryngeal nerve injury, recurrent laryngeal nerve injury, gland injury, cerebrospinal fluid leakage, internal plant infection, internal fixation loosening and displacement occurred. The operation time in ROI-C group and locking plate group was (81.33±10.74) min and (93.67±11.59) min respectively, the intraoperative bleeding volume was (77.33±22.43) mL and (108.33±24.08) mL respectively, and the differences were statistically significant (P＜0.05). The VAS score and JOA score in the two groups were significantly improved post-operation as compared with those before operation, the difference was statistically significant (P＜0.05), but there was no significant difference between the two groups in different followed-up time after opertion (P＞0.05). There was significant difference in Cobb angle in different follow-up time post-opertion (P＜0.05), while there was no significant difference between ROI-C group and locking plate group in fusion segment height pre- and post-opertion (P＞0.05). The incidence of postoperative swallowing discomfort in ROI-C group and titanium plate group was 6.67% (2/30) and 35.48% (11/31), respectively. There was significant difference between the two groups (χ2=7.550, P=0.005). No special treatment was given, and the dysphagia gradually disappeared during the postoperative follow-up. Bone fusion was obtained in all patients at the last follow-up. Conclusion ROI-C and locking plate can both achieve good clinical effect in the treatment of single segmental cervical spondylosis, but ROI-C has shorter operating time, less bleeding, lowed incidence of postoperative swallowing discomfort and loss of physiological curvature of cervical spine, which is worthy of clinical promotion. |
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