CAJ | 학술논문

目的探讨应用颈椎动态稳定器(dynamic cervical implant,DCI)治疗颈椎间盘突出症的安全性及早期临床疗效.方法 2009年9月至2010年12月,应用颈前路DCI治疗31例颈椎间盘突出症患者,记录并统计分析手术时间和出血量；采用颈椎残障功能指数(neck disability index,NDI)、日本矫形外科协会(Japanese Orthopaedic Association,JOA)评分评价神经功能改善情况,评估患者手术前后的疼痛视觉模拟评分(visual analogue scale,VAS).在X线片上测量术前和末次随访时植入节段的运动范围、手术节段脊柱功能单位(functional spine unit,FSU)高度与上位椎体高度比值(H/h)等的差异.结果 31例患者的手术时间为(45±15) min,出血量为(100±30) ml.术后随访6～20个月,平均14个月.术前与末次随访时植入节段的运动范围(9.6°±4.2°vs.6.9°±5.3°,P＞0.05)、H/h(2.6±0.1 vs.2.5±0.1,P＞0.05)和FSU的角度(2.6°±5.2°vs.1.7°±2.9°,P＞0.05)差异无统计学意义；而术前与末次随访时NDI(50.5±16.2vs.19.6±4.3,P＜ 0.05)、JOA评分(12.3±1.6 vs.13.9±1.8,P＜ 0.05)及颈痛VAS(6.3±2.6 vs.3.1±2.2,P＜0.05)差异有统计学意义.结论应用DCI非融合技术治疗颈椎间盘突出症,手术时间短,出血少,可以早期保留手术节段的运动功能,维持了椎间高度,早期临床效果满意.
목적 탐토응용경추동태은정기(dynamic cervical implant,DCI)치료경추간반돌출증적안전성급조기림상료효.방법 2009년9월지2010년12월,응용경전로DCI치료31례경추간반돌출증환자,기록병통계분석수술시간화출혈량；채용경추잔장공능지수(neck disability index,NDI)、일본교형외과협회(Japanese Orthopaedic Association,JOA)평분평개신경공능개선정황,평고환자수술전후적동통시각모의평분(visual analogue scale,VAS).재X선편상측량술전화말차수방시식입절단적운동범위、수술절단척주공능단위(functional spine unit,FSU)고도여상위추체고도비치(H/h)등적차이.결과 31례환자적수술시간위(45±15) min,출혈량위(100±30) ml.술후수방6～20개월,평균14개월.술전여말차수방시식입절단적운동범위(9.6°±4.2°vs.6.9°±5.3°,P＞0.05)、H/h(2.6±0.1 vs.2.5±0.1,P＞0.05)화FSU적각도(2.6°±5.2°vs.1.7°±2.9°,P＞0.05)차이무통계학의의；이술전여말차수방시NDI(50.5±16.2vs.19.6±4.3,P＜ 0.05)、JOA평분(12.3±1.6 vs.13.9±1.8,P＜ 0.05)급경통VAS(6.3±2.6 vs.3.1±2.2,P＜0.05)차이유통계학의의.결론 응용DCI비융합기술치료경추간반돌출증,수술시간단,출혈소,가이조기보류수술절단적운동공능,유지료추간고도,조기림상효과만의.
Objective To investigate the safety and early clinical efficiency of dynamic cervical implant (DCI) internal fixation to treat cervical disc herniation.Methods From September 2009 to December 2010,31 patients with herniation of cervical disc underwent DCI implantation.The operation time and blood loss were recorded and analyzed.Neck disability index (NDI),Japanese Orthopaedic Association (JOA) score,and visual analogue scale (VAS) score were used to evaluate neurofunctional recovery pre- and post-operation.Routinely,the patients accepted X-ray examination preoperatively and postoperatively.We used White's measurement to measure the range of motion(ROM) and height ratio of implant segment and the superior vertebra pre- and post-operation.Results The average operation time and amount of bleeding were 45 (30-60) min and (100±30) ml respectively.The average postoperative follow-up was 14 months (range,6-20).The average NDI (50.5±16.2 vs.19.6±4.3,P＜0.05),JOA score (12.3±1.6 vs.13.9±1.8,P＜0.05) and VAS score (6.3±2.6 vs.3.1±2.2,P＜0.05) changed significantly at the last follow-up compared with those pre-operation.There were no significant differences in the average ROM of implant segment (9.6°±4.2° vs.6.9°±5.3°,P＞0.05),the height ratio of implant segment and the superior vertebra (2.6±0.1 vs.2.5±0.1,P＞0.05) and the angle of functional spine unit (2.6°±5.2° vs.1.7°±2.9°,P＞0.05) at last follow-up compared with those preoperation.Conclusion Using DCI to treat cervical disc herniation had shorter operation time and less bleeding advantages,and the early clinical effect was satisfactory.It may retain the cervical biomechanical movement in some degree,maintain the cervical stability.