零切跡椎間融合固定系統治療頸椎間盤突出癥的早期療效觀察_《中國修復重建外科雜志》

作者：

俞武良 , 陸建猛 , 韋勇力 , 方明 , 王興武 , 歐陽甲

寧波大學醫學院附屬醫院脊柱外科（浙江寧波，315020）;

關鍵詞：

頸椎間盤突出癥頸前路椎間盤切除植骨融合術零切跡椎間融合固定系統

DOI：

10.7507/1002-1892.20130152

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目的探討應用零切跡椎間融合固定系統（Zero-profile interbody fusion system，Zero-P）治療頸椎間盤突出癥的早期療效。方法2010年10月－2012年6月應用前路減壓、Zero-P系統椎間植骨內固定治療25例頸椎間盤突出癥患者。男15例，女10例；年齡35～68歲，平均49歲。病程3～26個月，平均10.5個月。病變節段：C3、 4 2例，C4、 5 5例，C5、 6 11例，C6、 7 7例。記錄手術時間、術中出血量；于術前、術后3個月及末次隨訪時行疼痛視覺模擬評分（VAS）、日本骨科協會（JOA）評分、頸椎功能障礙指數（NDI）評定，評價疼痛及神經功能改善情況；攝X線片測量手術前后頸椎Cobb角，根據Pitzen等的頸椎間融合評價標準評定椎間植骨融合情況。結果25例均順利完成手術，術中出血量20～120 mL，平均42.6 mL；手術時間45～90 min，平均63.6 min。術后切口均Ⅰ期愈合，無脊髓、神經根損傷及腦脊液漏、深部感染等并發癥發生。術后25例均獲隨訪，隨訪時間6～23個月，平均14.5個月。術后無椎間融合器下沉及螺釘松動、斷裂、拔出等內固定失敗發生。患者臨床癥狀及頸椎生理曲度均明顯改善，術后3個月及末次隨訪時VAS評分、JOA評分、NDI及頸椎Cobb角與術前比較，差異均有統計學意義（P lt; 0.05）；術后3個月與末次隨訪時比較差異均無統計學意義（P gt; 0.05）。術后6個月復查頸椎X線片，根據Pitzen等頸椎間融合評價標準，25例椎間植骨均融合。結論前路減壓、應用Zero-P系統椎間植骨內固定治療頸椎間盤突出癥具有手術時間短、出血少、穩定性好、可重建頸椎生理曲度等優點，早期療效滿意。

引用本文： 俞武良,陸建猛,韋勇力,方明,王興武,歐陽甲. 零切跡椎間融合固定系統治療頸椎間盤突出癥的早期療效觀察. 中國修復重建外科雜志, 2013, 27(6): 686-689. doi: 10.7507/1002-1892.20130152 復制

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11.	Bijur PE, Silver W, Gallagher EJ. Reliability of the visual analog scale for measurement of acute pain. Acad Emerg Med, 2001, 8(12): 1153-1157.
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13.	Pitzen TR, Chrobok J, Stulik J, et al. Implant complications, fusion, loss of lordosis, and outcome after anterior cervical plating with dynamic or rigid plates: two-year results of a multicentric, randomized, controlled study. Spine (Phila Pa 1976), 2009, 34(7): 641-646.
14.	Scholz M, Schnake KJ, Pingel A, et al. A New Zero-profile Implant for Stand-alone Anterior Cervical Interbody Fusion. Clin Orthop Relat Res, 2011, 469(3): 666-673.
15.	Jacobs W, Willems PC, Kruyt M, et al. Systematic review of anterior interbody fusion techniques for single- and double-level cervical degenerative disc disease. Spine (Phila Pa 1976), 2011, 36(14): E950-960.
16.	林秋水, 王新偉, 袁文, 等. 前路經椎間隙減壓植骨融合術治療老年多節段脊髓型頸椎病的療效觀察. 中國脊柱脊髓雜志, 2010, 20(7): 562-566.
17.	張建喬, 金才益, 曾忠友, 等. 頸前路分段減壓植骨融合術治療多節段脊髓型頸椎病. 中國修復重建外科雜志, 2010, 24(12): 1476-1479.
18.	Tortolani PJ, Cunningham BW, Vigna F, et al. A comparison of retraction pressure during anterior cervical plate surgery and cervical disc replacement: a cadaveric study. J Spinal Disord Tech, 2006, 19(5): 312-317.
19.	Lee MJ, Bazaz R, Furey CG, et al. Influence of anterior cervical plate design on dysphagia: a 2-year prospective longitudinal follow-up study. J Spinal Disord Tech, 2005, 18(5): 406-409.
20.	Kasimatis GB, Panagiotopoulos E, Gliatis J, et al. Complications of anterior surgery in cervical spine trauma: an overview. Clin Neurol Neurosurg, 2009, 111(1): 18-27.
21.	Fountas KN, Kapsalaki EZ, Nikolakakos LG, et al. Anterior cervical discectomy and fusion associated complications. Spine (Phila Pa 1976), 2007, 32(21): 2310-2317.
22.	Yue WM, Brodner W, Highland TR. Persistent swallowing and voice problems after anterior cervical discectomy and fusion with allograft and plating: a 5- to 11-year follow-up study. Eur Spine J, 2005, 14(7): 677-682.
23.	Scholz M, Reyes PM, Schleicher P, et al. A new stand-alone cervical anterior interbody fusion device: biomechanical comparison with established anterior cervical fixation devices. Spine (Phila Pa 1976), 2009, 34(2): 156-160.
24.	Kim SW, Limson MA, Kim SB, et al. Comparison of radiographic changes after ACDF versus Bryan disc arthroplasty in single and bi-level cases. Eur Spine J, 2009, 18(2): 218-231.

1. Korinth MC. Treatment of cervical degenerative disc disease: current status and trends. Zentralbl Neurochir, 2008, 69(3): 113-124.
2. Matz PG, Ryken TC, Groff MW, et al. Techniques for anterior cervical decompression for radiculopathy. J Neurosurg Spine, 2009, 11(2): 183-197.
3. Vanek P, Bradac O, DeLacy P, et al. Comparison of 3 fusion techniques in the treatment of the degenerative cervical spine disease. Is stand-alone autograft really the “gold standard?”: prospective study with 2-year follow-up. Spine (Phila Pa 1976), 2012, 37(19): 1645-1651.
4. Song KJ, Taghavi CE, Lee KB, et al. The efficacy of plate construct augmentation versus cage alone in anterior cervical fusion. Spine (Phila Pa 1976), 2009, 34(26): 2886-2892.
5. Song KJ, Taghavi CE, Hsu MS, et al. Plate augmentation in anterior cervical discectomy and fusion with cage for degenerative cervical spinal disorders. Eur Spine J, 2010, 19(10): 1677-1683.
6. Chin KR, Eiszner JR, Adams SB. Role of plate thickness as a cause of dysphagia after anterior cervical. Spine (Phila Pa 1976), 2007, 32(23): 2585-2590.
7. Rihn JA, Kane J, Albert TJ, et al. What is the incidence and severity of dysphagia after anterior cervical surgery? Clin Orthop Relat Res, 2011, 469(3): 658-665.
8. Park JB, Cho YS, Riew KD. Development of adjacent-level ossification in patients with an anterior cervical plate. J Bone Joint Surg (Am), 2005, 87(3): 558-563.
9. Kim HJ, Kelly MP, Ely CG, et al. The risk of adjacent-level ossification development after surgery in the cervical spine: are there factors that affect the risk? A systematic review. Spine (Phila Pa 1976), 2012, 37(22 Suppl): S65-74.
10. Vernon H, Mior S. The Neck Disability Index: a study of reliability and validity. Manipulative Physiol Ther, 1991, 14(7): 409-415.
11. Bijur PE, Silver W, Gallagher EJ. Reliability of the visual analog scale for measurement of acute pain. Acad Emerg Med, 2001, 8(12): 1153-1157.
12. Hirabayashi K, Miyakawa J, Satomi K, et al. Operative results and postoperative progression of ossification among patients with ossification of cervical posterior longitudinal ligament. Spine (Phila Pa 1976), 1981, 6(4): 354-364.
13. Pitzen TR, Chrobok J, Stulik J, et al. Implant complications, fusion, loss of lordosis, and outcome after anterior cervical plating with dynamic or rigid plates: two-year results of a multicentric, randomized, controlled study. Spine (Phila Pa 1976), 2009, 34(7): 641-646.
14. Scholz M, Schnake KJ, Pingel A, et al. A New Zero-profile Implant for Stand-alone Anterior Cervical Interbody Fusion. Clin Orthop Relat Res, 2011, 469(3): 666-673.
15. Jacobs W, Willems PC, Kruyt M, et al. Systematic review of anterior interbody fusion techniques for single- and double-level cervical degenerative disc disease. Spine (Phila Pa 1976), 2011, 36(14): E950-960.
16. 林秋水, 王新偉, 袁文, 等. 前路經椎間隙減壓植骨融合術治療老年多節段脊髓型頸椎病的療效觀察. 中國脊柱脊髓雜志, 2010, 20(7): 562-566.
17. 張建喬, 金才益, 曾忠友, 等. 頸前路分段減壓植骨融合術治療多節段脊髓型頸椎病. 中國修復重建外科雜志, 2010, 24(12): 1476-1479.
18. Tortolani PJ, Cunningham BW, Vigna F, et al. A comparison of retraction pressure during anterior cervical plate surgery and cervical disc replacement: a cadaveric study. J Spinal Disord Tech, 2006, 19(5): 312-317.
19. Lee MJ, Bazaz R, Furey CG, et al. Influence of anterior cervical plate design on dysphagia: a 2-year prospective longitudinal follow-up study. J Spinal Disord Tech, 2005, 18(5): 406-409.
20. Kasimatis GB, Panagiotopoulos E, Gliatis J, et al. Complications of anterior surgery in cervical spine trauma: an overview. Clin Neurol Neurosurg, 2009, 111(1): 18-27.
21. Fountas KN, Kapsalaki EZ, Nikolakakos LG, et al. Anterior cervical discectomy and fusion associated complications. Spine (Phila Pa 1976), 2007, 32(21): 2310-2317.
22. Yue WM, Brodner W, Highland TR. Persistent swallowing and voice problems after anterior cervical discectomy and fusion with allograft and plating: a 5- to 11-year follow-up study. Eur Spine J, 2005, 14(7): 677-682.
23. Scholz M, Reyes PM, Schleicher P, et al. A new stand-alone cervical anterior interbody fusion device: biomechanical comparison with established anterior cervical fixation devices. Spine (Phila Pa 1976), 2009, 34(2): 156-160.
24. Kim SW, Limson MA, Kim SB, et al. Comparison of radiographic changes after ACDF versus Bryan disc arthroplasty in single and bi-level cases. Eur Spine J, 2009, 18(2): 218-231.

《中國修復重建外科雜志》

零切跡椎間融合固定系統治療頸椎間盤突出癥的早期療效觀察

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《中國修復重建外科雜志》

零切跡椎間融合固定系統治療頸椎間盤突出癥的早期療效觀察

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