组织工程与重建外科杂志 ›› 2023, Vol. 19 ›› Issue (4): 391-.

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颈椎前路自稳型融合器治疗双节段脊髓型颈椎病的疗效及中期随访

  

  • 出版日期:2023-08-01 发布日期:2023-09-06

 Curative effect and mid-term follow-up analysis of anterior cervical self- stabilizing cage in the treatment of double-segment cervical spondylotic myelopathy 

  • Online:2023-08-01 Published:2023-09-06

摘要:

 目的 探讨颈椎前路自稳型融合器治疗双节段脊髓型颈椎病的疗效及中期随访分析。方法 选取自 2021年 1 月至 2021 年 12 月在我院行颈椎前路椎间盘切除融合术的双节段脊髓型颈椎病 50 例,随机分为观察组和对照组,每组各 25 例。观察组采用颈椎前路零切迹自稳型椎间融合器,对照组采用传统钉板系统内固定融合器。全部患者术后随访 6 个月以上。观察两组患者的手术时间、术中出血量 ;术前和术后 3、6 个月的颈椎功能障碍指数(Neckdisability index,NDI)评分,以及日本骨科协会(Japanese Orthopaedic Association,JOA)评分、植骨融合率、颈部和上肢的视觉疼痛模拟评分(Visual analog scale,VAS)评分、神经功能改善率等 ;观察 C2~7 的 Cobb 角和 SVA、T1S 及节段角度等颈椎影像学指标 ;观察两组术后并发症发生率。结果 两组患者的手术时间和术中出血量对比具有统计学差异(P<0.05),住院时间对比无统计学差异(P>0.05)。两组患者术后 3 个月及 6 个月随访时的 NDI 评分、JOA 评分、颈部 VAS 评分、上肢 VAS 评分及神经功能改善率均优于术前(P<0.05);但在术前和术后 3、6 个月随访时,组间对比无统计学差异(P>0.05)。观察组和对照组各时间点植骨融合率均无统计学差异(P>0.05)。两组患者在术后 3 个月及 6 个月随访时,C2~7 的 Cobb 角、SVA 和 T1S 及节段角度均优于术前(P<0.05);但组间对比无统计学差异(P>0.05)。观察组术后吞咽困难发生率明显低于对照组(P<0.05),在术后其他并发症的对比上无统计学差异(P>0.05)。结论 颈椎前路自稳型融合器在治疗双节段脊髓型颈椎病中疗效优良,手术时间短,术后吞咽困难发生率低。

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Abstract:

Objective To investigate the efficacy and mid-term follow-up analysis of anterior cervical self-stabilizing cage in the treatment of double-segment cervical spondylotic myelopathy. Methods Fifty patients with double-segment cervical spondylotic myelopathy who underwent anterior cervical discectomy and fusion in our hospital from January 2021 to December
2021 were selected, and they were randomly divided into the observation group and the control group, with 25 cases in each
group. The patients in the observation group were treated with anterior cervical approach zero-notch self-stabilizing interbody
cage, while the patients in the control group were treated with the traditional screw-plate system internal fixation cage. A 6-month
interim follow-up was performed postoperatively. The operation time, intraoperative blood loss, NDI score, JOA score, bone graft
fusion rate, neck VAS score, upper limb VAS score, neurological function improvement rate before operation, 3 months after operation and 6 months after operation were observed in the two groups. And cervical imaging indicators such as C2-7Cobb angle,
C2-7SVA, T1S and segmental angle were measured. The incidence of postoperative complications in the two groups was observed. Results The operation time and intraoperative blood loss were significantly different between the two groups (P<0.05),
but there was no significant difference in hospitalization time between the two groups (P>0.05). The NDI score, JOA score, bone
graft fusion rate, neck VAS score, upper extremity VAS score and neurological function improvement rate of the two groups at
3-month and 6-month follow-up were all better than those before operation (P<0.05). However, there was no significant difference in preoperative, 3-month and 6-month follow-up (P>0.05). There was no significant difference in bone graft fusion ratebetween observation group and control group at each time point (P<0.05). The C2-7 Cobb angle, C2-7SVA, T1S and segmentalangle of the two groups at 3-month postoperative and mid-term 6-month follow-up were better than those before surgery (P<0.05).
However, there was no significant difference in preoperative, 3-month and 6-month follow-up (P>0.05). The incidence of postoperative dysphagia in the observation group was significantly lower than that in the control group (P<0.05), and there was no
significant difference in other postoperative complications between the two groups (P>0.05). Conclusion The anterior cervical
self-stabilizing cage has good curative effect in the treatment of double-segment cervical spondylotic myelopathy, with short operation time and low incidence of postoperative dysphagia.

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