摘要
目的针对双节段颈椎前路减压融合术(ACDF)术中应用ROI-C零切迹融合器与传统Cage+钛板内固定的临床效果进行比较。方法以2018年1月~2021年1月河南省人民医院脊柱脊髓外科收治的65例连续双节段脊髓型颈椎病患者作为研究对象,均予以双节段ACDF手术,根据术中内植物分为两组:ROI-C组31例,术中植入ROI-C零切迹融合器;Cage+钛板组34例,术中均植入Cage+前路钛板固定。术后随访2年以上,对两组患者各项指标进行分组比较。结果与Cage+钛板组相比,ROI-C组患者的手术时间显著缩短(P<0.05),且ROI-C组患者的术中出血量显著减少(P<0.05)。ROI-C组术后出现吞咽困难2例(6.45%),均为轻度;Cage+钛板组出现8例(23.53%),其中轻度6例、中度2例,术后吞咽困难发生率有显著性差异(P<0.05)。与术前相比,两组患者术后3个月和末次随访的JOA评分和NDI指数均得到显著改善(P<0.05),但组间差异不显著(P>0.05)。末次随访时,按照Odoms标准:ROI-C组优19例、良12例,Cage+钛板组优20例、良14例,组间差异不显著(P>0.05)。与术前相比,两组患者术后3个月、末次随访时的C_(2-7) Cobb角和节段前凸角均获得了显著的矫正(P<0.05),但组间差异不显著(P>0.05)。截止末次随访,两组均获得植骨融合,融合率均为100%;ROI-C组未见嵌片松脱和融合器明显位移等现象,Cage+钛板组未见钛板松脱、断裂等现象。结论连续双节段脊髓型颈椎病ACDF应用ROI-C融合器和Cage+钛板均可获得满意的手术疗效。应用ROI-C融合器可缩短手术时间、减少术中出血量,并降低术后吞咽困难的发生率。
Objective To compare the clinical effects of using ROI-C zero notch fusion cage and traditional Cage+titanium plate internal fixation in anterior cervical decompression and fusion(ACDF)surgery with dual segment cervical spine.Methods 65 consecutive patients with dual segment cervical spondylotic myelopathy admitted to our department from January 2018 to January 2021 were selected as the study subjects,all of whom underwent dual segment ACDF surgery.They were divided into two groups based on the type of intraoperative implant:the ROI-C group of 31 patients,all of whom were implanted with ROI-C zero notch fusion cages during the surgery;In the Cage+titanium plate group of 34 cases,Cage+anterior titanium plate fixation was implanted during surgery.More than 2 years were followed up after surgery and various indicators were compared between the two groups of patients.Results Compared with the Cage+titanium plate group,the surgical time of patients in the ROI-C group was significantly shortened(P<0.05),and the intraoperative bleeding volume of patients in the ROI-C group was significantly reduced(P<0.05).There were 2 cases(6.45%)of postoperative dysphagia in the ROI-C group,all of which were mild;There were 8 cases(23.53%)in the Cage+titanium plate group,including 6 mild cases and 2 moderate cases;There was a significant difference in the incidence of dysphagia between the two groups of patients(P<0.05).Compared with preoperative,the JOA score and NDI index of the two groups of patients at 3 months and the last follow-up were significantly improved(P<0.05),but there was no significant difference between the groups(P>0.05).At the last follow-up,according to Odoms criteria,there were 19 excellent and 12 good cases in the ROI-C group,and 20 excellent and 14 good cases in the Cage+titanium plate group,with no significant difference between the groups(P>0.05).Compared with before surgery,the C_(2-7) Cobb angle and segmental protrusion angle of the two groups of patients were significantly corrected at 3 months after surgery and at the last follow-up(P<0.05),but the difference between the groups was not significant(P>0.05).As of the last follow-up,both groups received bone graft fusion,with a fusion rate of 100%;There was no looseness or significant displacement of the fusion device in the ROI-C group,while there was no looseness or fracture of the titanium plate in the Cage+titanium plate group.Conclusions In ACDF surgery for patients with continuous two-stage cervical spondylotic myelopathy,the use of ROI-C fusion cage and Cage+titanium plate can achieve satisfactory surgical results,and the curvature of the cervical spine and the anterior convex angle of the surgical segment can be corrected;However,intraoperative implantation of ROI-C fusion cage can shorten surgical time,reduce intraoperative bleeding,and reduce the incidence of postoperative swallowing difficulties.
作者
马龙
邹海涛
盛伟超
孙国绍
MA Long;ZOU Hai-tao;SHENG Wei-chao;SUN Guo-shao(Department of Pain Medicine of Sanya Central Hospital,Sanya,Hainan 572000,China;Department of Spinal Surgery of Henan Provincial People's Hospital,Zhengzhou,Henan 450000,China;Department of Neurospinal Surgery of Zhengzhou Central Hospital,Zhengzhou,Henan 450000,China)
出处
《颈腰痛杂志》
2024年第5期895-901,共7页
The Journal of Cervicodynia and Lumbodynia
关键词
脊髓型颈椎病
颈椎前路减压融合术
ROI-C融合器
零切迹
吞咽困难
cervical spondylotic myelopathy
anterior cervical decompression and fusion surgery
ROI-C fusion device
Zero notch
dysphagia
