零切跡頸前路椎間融合固定系統治療頸椎病的早期療效分析_《中國修復重建外科雜志》

作者：

方明 , 陸建猛 , 韋勇力 , 俞武良 , 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：

頸椎病零切跡頸前路椎間融合固定系統頸前路融合術

DOI：

10.7507/1002-1892.20130264

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目的評價應用零切跡頸前路椎間融合固定系統（Zero-profile implant system，Zero-P）行頸前路融合術的早期療效。方法2010年3月－2011月6月收治頸椎病患者25例，男13例，女12例；年齡26～67歲，平均44.2歲。病程3～120個月，中位病程25個月。其中神經根型頸椎病14例，脊髓型6例，混合型5例。單節段20例，雙節段4例，三節段1例。初次行頸椎手術者23例，頸椎術后再手術2例。均行經前路椎間盤切除減壓、Zero-P固定術；共植入Zero-P 31枚，其中C3、4 3枚、C4、5 8枚、C5、6 12枚、C6、7 8枚；手術前后定期攝X線片，測量椎間隙高度、頸椎Cobb角，采用疼痛視覺模擬評分（VAS）記錄頸痛與上肢痛、日本骨科協會（JOA）評分評價脊髓功能；并觀察植骨融合及吞咽不適相關并發癥的發生情況。結果術后切口均Ⅰ期愈合。25例均獲隨訪，隨訪時間12～16個月，平均13.9個月。31個椎間隙均獲骨性融合，融合時間2.7～6.0個月，平均3.8個月。3例患者術后出現吞咽不適，其中2例表現為吞咽痛，術后1周內癥狀消失；1例訴咽部異物感，癥狀持續至術后3個月消失。隨訪期間未見內固定物松動、沉降、斷裂等情況。術前及術后1周、12個月患者椎間隙高度分別為（4.5 ± 0.5）、（6.0 ± 0.7）、（5.7 ± 0.6）mm，頸椎Cobb角分別為（11.9 ± 6.1）、（21.2 ± 4.1）、（20.2 ± 3.7）°，術后兩時間點均較術前顯著改善（P lt; 0.05），術后兩時間點間比較差異無統計學意義（P gt; 0.05）。術前及術后3、12個月患者VAS評分分別為（7.1 ± 0.8）、（1.9 ± 0.8）、（1.0 ± 0.5）分，JOA評分分別為（9.6 ± 1.3）、（13.5 ± 1.0）、（14.9 ± 1.0）分，術后兩時間點均較術前顯著改善（P lt; 0.05），術后兩時間點間比較差異也有統計學意義（P lt; 0.05）。結論Zero-P治療頸椎病手術效果好，融合率高，術后吞咽不適相關并發癥發生率低，可重建并維持頸椎高度和曲度，早期療效滿意。

引用本文： 方明,陸建猛,韋勇力,俞武良,王興武,歐陽甲. 零切跡頸前路椎間融合固定系統治療頸椎病的早期療效分析. 中國修復重建外科雜志, 2013, 27(10): 1206-1209. doi: 10.7507/1002-1892.20130264 復制

1.	Vaccaro AR, Cearrino JA, Venger BH, et al. Use of a bioabsorbable anterior cervical plate in the treatment of cervical degenerative and traumatic disc disruption. J Neurosurg, 2002, 97(4): 473-480.
2.	Korinth MC. Treatment of cervical degenerative disc disease: current status and trends. Zentralbl Neurochir, 2008, 69(3): 113-124.
3.	Matz PG, Ryken TC, Groff MW, et al. Techniques for anterior cervica decompression for radiculopathy. J Neurosurg Spine, 2009, 11(2): 183-197.
4.	Fujibayashi S, Neo M, Nakamura T. Stand-alone interbody cage versus anterior cervical plate for treatment of cervical disc hernation: sequential changes in cage subsidence. J Clin Neurosci, 2008, 15(9): 1017-1022.
5.	Moon HJ, Kim JH, Kim JH, et al. The effects of anterior cervical discectomy and fusion with stand-alone cages at two contiguous levels on cervical alignment and outcomes. Acta Neurochir, 2011, 153(3): 559-565.
6.	Anderson DG, Albert TJ. Bone grafting, implants, and plating options for anterior cervical fusions. Orthop Clin North Am, 2002, 33(2): 317-328.
7.	Böhler J, Gaudernak T. Anterior plate stabilization for fracturedislocations of the lower cervical spine. J Trauma, 1980, 20(3): 203-205.
8.	Scholz M, Schnake KL, 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.
9.	Yang JY, Song HS, Lee M, et al. Adjacent level ossification deveIopment after anterior cervical fusion without plate fixation. Spine (Phila Pa 1976), 2009, 34(1): 30-33.
10.	Hwang SH, Kayanja M, Milks RA, et al. Biomechanical comparison of adjacent segmental motion after ventral cervical fixaton with varying angles of lordosis. Spine (Phila Pa 1976), 2007, 7(2): 216-221.
11.	Faldini C, Pagkrati S, Leonetti D, et al. Sagittal segmental alignment as predictor of adjacent-level degeneration after a cloward procedure. Clin Orthop Relat Res, 2011, 469(3): 674-681.
12.	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.
13.	Bazaz R, Lee MJ, Yoo JU. Incidence of dysphagia after anterior cervical spine surgery: a prospective study. Spine (Phila Pa 1976), 2002, 27(22): 2453-2458.
14.	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.
15.	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.
16.	Bazaz R, Lee MJ, Yoo JU. Incidence of dysphagia after anterior cervical spine surgery: a prospective study. Spine (Phila Pa 1976), 2002, 27(22): 2453-2458.
17.	Fountas KN, Kapsalaki EZ, Nikolakakos LG, et al. Anterior cervical discectomy and fusion associated complications. Spine (Phila Pa 1976), 2007, 32(21): 2310-2317.
18.	Riley LH 3rd, Skolasky RL, Albert TJ, et al. Dysphagia after anterior cervical decompression and fusion: prevalence and risk factors from a longitudinal cohort study. Spine (Phila Pa 1976), 2005, 30(22): 2564-2569.
19.	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.

1. Vaccaro AR, Cearrino JA, Venger BH, et al. Use of a bioabsorbable anterior cervical plate in the treatment of cervical degenerative and traumatic disc disruption. J Neurosurg, 2002, 97(4): 473-480.
2. Korinth MC. Treatment of cervical degenerative disc disease: current status and trends. Zentralbl Neurochir, 2008, 69(3): 113-124.
3. Matz PG, Ryken TC, Groff MW, et al. Techniques for anterior cervica decompression for radiculopathy. J Neurosurg Spine, 2009, 11(2): 183-197.
4. Fujibayashi S, Neo M, Nakamura T. Stand-alone interbody cage versus anterior cervical plate for treatment of cervical disc hernation: sequential changes in cage subsidence. J Clin Neurosci, 2008, 15(9): 1017-1022.
5. Moon HJ, Kim JH, Kim JH, et al. The effects of anterior cervical discectomy and fusion with stand-alone cages at two contiguous levels on cervical alignment and outcomes. Acta Neurochir, 2011, 153(3): 559-565.
6. Anderson DG, Albert TJ. Bone grafting, implants, and plating options for anterior cervical fusions. Orthop Clin North Am, 2002, 33(2): 317-328.
7. Böhler J, Gaudernak T. Anterior plate stabilization for fracturedislocations of the lower cervical spine. J Trauma, 1980, 20(3): 203-205.
8. Scholz M, Schnake KL, 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.
9. Yang JY, Song HS, Lee M, et al. Adjacent level ossification deveIopment after anterior cervical fusion without plate fixation. Spine (Phila Pa 1976), 2009, 34(1): 30-33.
10. Hwang SH, Kayanja M, Milks RA, et al. Biomechanical comparison of adjacent segmental motion after ventral cervical fixaton with varying angles of lordosis. Spine (Phila Pa 1976), 2007, 7(2): 216-221.
11. Faldini C, Pagkrati S, Leonetti D, et al. Sagittal segmental alignment as predictor of adjacent-level degeneration after a cloward procedure. Clin Orthop Relat Res, 2011, 469(3): 674-681.
12. 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.
13. Bazaz R, Lee MJ, Yoo JU. Incidence of dysphagia after anterior cervical spine surgery: a prospective study. Spine (Phila Pa 1976), 2002, 27(22): 2453-2458.
14. 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.
15. 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.
16. Bazaz R, Lee MJ, Yoo JU. Incidence of dysphagia after anterior cervical spine surgery: a prospective study. Spine (Phila Pa 1976), 2002, 27(22): 2453-2458.
17. Fountas KN, Kapsalaki EZ, Nikolakakos LG, et al. Anterior cervical discectomy and fusion associated complications. Spine (Phila Pa 1976), 2007, 32(21): 2310-2317.
18. Riley LH 3rd, Skolasky RL, Albert TJ, et al. Dysphagia after anterior cervical decompression and fusion: prevalence and risk factors from a longitudinal cohort study. Spine (Phila Pa 1976), 2005, 30(22): 2564-2569.
19. 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.

《中國修復重建外科雜志》

零切跡頸前路椎間融合固定系統治療頸椎病的早期療效分析

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《中國修復重建外科雜志》

零切跡頸前路椎間融合固定系統治療頸椎病的早期療效分析

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