CAJ | 학술논문

目的比较椎间桥形固定颈部融合器(ROI-C)与传统颈椎前路椎间融合器联合钛板治疗脊髓型颈椎病的临床疗效.方法 2011年4月至2012年10月对66例脊髓型颈椎病患者行颈椎前路减压融合术(ACDF)治疗,23例患者采用ROI-C作为内植物(ROI-C组),43例患者采用椎间融合器和前路钛板作为内植物(钛板组).采用日本骨科学会(JOA)评分和视觉模拟量表(VAS)评分对患者术前、术后功能进行评估.记录两组手术时间、术中出血量、术中透视次数、术后吞咽困难以及椎间植骨融合情况.对于手术前后JOA评分、颈痛VAS评分、上肢痛VAS评分采用配对t检验,组间研究指标的比较采用独立样本的t检验或x2检验.结果所有患者均获得随访,ROI-C组随访12～38个月;钛板组随访14 ～ 39个月.两组患者的年龄、性别、术前JOA评分、VAS评分、手术节段构成比以及随访时间差异均无统计学意义(P＞0.05).ROI-C组手术时间[(123±38) min]、术中出血量[(84 ±37)ml]、术中透视次数[(3.5±0.7)次]均明显低于钛板组[(165±60) min、(128±66) ml、(5.9±1.2)次],差异均有统计学意义(t=-3.27、-3.25、-9.45,P=0.02、0.02、0.00).两组术后1、3个月及末次随访时JOA评分均显著高于术前水平,差异有统计学意义(ROI-C组:t=11.94、11.32和10.60,均P=0.00;钛板组:t=15.07、19.51和17.55,均P=0.00).两组术后l、3个月及末次随访时颈痛VAS评分和上肢痛VAS评分均显著低于术前水平,差异有统计学意义(ROI-C组:t=-16.64～-9.68,均P=0.00;钛板组:f=-16.56 ～-12.38,均P=0.00);但两组间在相同时间点的JOA评分、颈痛VAS评分以及上肢痛VAS评分,差异无统计学意义(P＞0.05).ROI-C组术后吞咽困难发生率较钛板组明显降低,差异有统计学意义(x2=6.79,P=0.01).所有患者在末次随访时手术节段均获得骨性愈合,两组差异无统计学意义(P＞0.05).结论 ROI-C与传统颈椎前路椎间融合器联合钛板治疗脊髓型颈椎病均可取得较好的临床疗效,但ROI-C具有操作简便、手术时间短、术中出血量以及透视次数少、术后吞咽困难发生率低等优点. 目的比較椎間橋形固定頸部融閤器(ROI-C)與傳統頸椎前路椎間融閤器聯閤鈦闆治療脊髓型頸椎病的臨床療效.方法 2011年4月至2012年10月對66例脊髓型頸椎病患者行頸椎前路減壓融閤術(ACDF)治療,23例患者採用ROI-C作為內植物(ROI-C組),43例患者採用椎間融閤器和前路鈦闆作為內植物(鈦闆組).採用日本骨科學會(JOA)評分和視覺模擬量錶(VAS)評分對患者術前、術後功能進行評估.記錄兩組手術時間、術中齣血量、術中透視次數、術後吞嚥睏難以及椎間植骨融閤情況.對于手術前後JOA評分、頸痛VAS評分、上肢痛VAS評分採用配對t檢驗,組間研究指標的比較採用獨立樣本的t檢驗或x2檢驗.結果所有患者均穫得隨訪,ROI-C組隨訪12～38箇月;鈦闆組隨訪14 ～ 39箇月.兩組患者的年齡、性彆、術前JOA評分、VAS評分、手術節段構成比以及隨訪時間差異均無統計學意義(P＞0.05).ROI-C組手術時間[(123±38) min]、術中齣血量[(84 ±37)ml]、術中透視次數[(3.5±0.7)次]均明顯低于鈦闆組[(165±60) min、(128±66) ml、(5.9±1.2)次],差異均有統計學意義(t=-3.27、-3.25、-9.45,P=0.02、0.02、0.00).兩組術後1、3箇月及末次隨訪時JOA評分均顯著高于術前水平,差異有統計學意義(ROI-C組:t=11.94、11.32和10.60,均P=0.00;鈦闆組:t=15.07、19.51和17.55,均P=0.00).兩組術後l、3箇月及末次隨訪時頸痛VAS評分和上肢痛VAS評分均顯著低于術前水平,差異有統計學意義(ROI-C組:t=-16.64～-9.68,均P=0.00;鈦闆組:f=-16.56 ～-12.38,均P=0.00);但兩組間在相同時間點的JOA評分、頸痛VAS評分以及上肢痛VAS評分,差異無統計學意義(P＞0.05).ROI-C組術後吞嚥睏難髮生率較鈦闆組明顯降低,差異有統計學意義(x2=6.79,P=0.01).所有患者在末次隨訪時手術節段均穫得骨性愈閤,兩組差異無統計學意義(P＞0.05).結論 ROI-C與傳統頸椎前路椎間融閤器聯閤鈦闆治療脊髓型頸椎病均可取得較好的臨床療效,但ROI-C具有操作簡便、手術時間短、術中齣血量以及透視次數少、術後吞嚥睏難髮生率低等優點.
목적 비교추간교형고정경부융합기(ROI-C)여전통경추전로추간융합기연합태판치료척수형경추병적림상료효.방법 2011년4월지2012년10월대66례척수형경추병환자행경추전로감압융합술(ACDF)치료,23례환자채용ROI-C작위내식물(ROI-C조),43례환자채용추간융합기화전로태판작위내식물(태판조).채용일본골과학회(JOA)평분화시각모의량표(VAS)평분대환자술전、술후공능진행평고.기록량조수술시간、술중출혈량、술중투시차수、술후탄인곤난이급추간식골융합정황.대우수술전후JOA평분、경통VAS평분、상지통VAS평분채용배대t검험,조간연구지표적비교채용독립양본적t검험혹x2검험.결과 소유환자균획득수방,ROI-C조수방12～38개월;태판조수방14 ～ 39개월.량조환자적년령、성별、술전JOA평분、VAS평분、수술절단구성비이급수방시간차이균무통계학의의(P＞0.05).ROI-C조수술시간[(123±38) min]、술중출혈량[(84 ±37)ml]、술중투시차수[(3.5±0.7)차]균명현저우태판조[(165±60) min、(128±66) ml、(5.9±1.2)차],차이균유통계학의의(t=-3.27、-3.25、-9.45,P=0.02、0.02、0.00).량조술후1、3개월급말차수방시JOA평분균현저고우술전수평,차이유통계학의의(ROI-C조:t=11.94、11.32화10.60,균P=0.00;태판조:t=15.07、19.51화17.55,균P=0.00).량조술후l、3개월급말차수방시경통VAS평분화상지통VAS평분균현저저우술전수평,차이유통계학의의(ROI-C조:t=-16.64～-9.68,균P=0.00;태판조:f=-16.56 ～-12.38,균P=0.00);단량조간재상동시간점적JOA평분、경통VAS평분이급상지통VAS평분,차이무통계학의의(P＞0.05).ROI-C조술후탄인곤난발생솔교태판조명현강저,차이유통계학의의(x2=6.79,P=0.01).소유환자재말차수방시수술절단균획득골성유합,량조차이무통계학의의(P＞0.05).결론 ROI-C여전통경추전로추간융합기연합태판치료척수형경추병균가취득교호적림상료효,단ROI-C구유조작간편、수술시간단、술중출혈량이급투시차수소、술후탄인곤난발생솔저등우점.
Objective To study clinical outcomes following anterior cervical discectomy and fusion (ACDF) using ROI-C compared to traditional cage with anterior plating in treating the cervical spondylotic myelopathy.Methods A total of 66 patients with the cervical spondylotic myelopathy were treated with ACDF between April 2011 and October 2012.Twenty-three patients underwent ACDF using the ROI-C device were classified as the ROI-C group and 43 patients received traditional cage with anterior plating served as the titanium plate group.Related indicators,such as operation time,intraoperative blood loss,intraoperative fluoroscopy times,incidence of postoperative dysphagia and ratio of bone graft fusion were recorded and compared between two groups.The clinical outcomes were evaluated by Japanese Orthopaedic Association (JOA) scores and visual analog scale (VAS) scores.The pre-and postoperative results were compared with a paired sample t-test.The results between groups were compared utilizing the grouped t-test or x2 test.Results All cases were followed up.The follow-up period was 12 to 38 months and 14 to 39 months in ROI-C group and titanium plate group respectively.For the age,gender,the JOA scores,VAS scores of neck pain and arm pain during preoperative,the surgical level constituent ratio and the follow-up time,there were no significant differences between two groups.In ROI-C group,the operation time was (123 ± 38)minutes,intraoperative blood loss was (84 ± 37)ml,exposure times to the X-ray C-arm machine was (3.5 ± 0.7) times,which were all significantly lower than titanium plate group ((165 ± 60)minutes,(128 ± 66) ml,(5.9 ± 1.2) times respectively,t =-3.27,-3.25,-9.45,P =0.02,0.02,0.00).The mean JOA scores increased significantly from pre-surgery to 1 month postoperatively,3 months postoperatively,and last follow-up in ROI-C group (t =11.94,11.32,10.60,all P =0.00) and titanium plate group(t =15.07,19.51,17.55,all P =0.00).The mean VAS scores of neck pain and arm pain decreased significantly from pre-surgery to 1 month postoperatively,3 months postoperatively,and last follow-up in ROI-C group (t =-16.64--9.68,all P =0.00) and titanium group (t =-16.56--12.38,all P =0.00).There was no significant difference on JOA scores and VAS scores of neck pain and arm pain between the two groups at the same time (P ＞ 0.05).However,significant difference was observed in incidence of postoperative dysphagia (x2 =6.79,P =0.01).In addition,bony fusion was obtained in all cases at the last follow-up postoperatively.There was no significant difference on ratio of bone graft fusion between two groups.Conclusion The ROI-C leads to similar clinical outcomes compared to traditional cage combined with anterior plating for the treatment of the cervical spondylotic myelopathy,while the ROI-C carries a simpler operation,shorter operation time,less intraoperative blood loss,less exposure times to the X-ray and a lower risk of postoperative dysphagia.