CAJ | 학술논문

目的探讨ROI-C双嵌片白锁融合器在多节段脊髓型颈椎病前路减压融合术中的应用效果.方法 2010年3月至2013年9月采用颈椎前路减压融合术治疗多节段脊髓型颈椎病92例,男58例,女34例;年龄46～76,平均56.8岁.采用普通cage加钛板固定(cage+钛板组)52例,ROI-C双嵌片自锁融合器固定(ROI-C融合器组)40例.比较两组患者的术前情况、手术时间、术中出血量、手术前后椎间隙高度、颈椎Cobb角、植骨融合率、并发症发生率、手术前后日本骨科协会(Japanese Orthopedic Association,JOA)评分、颈痛及上肢疼痛视觉模拟评分(visual analogue scale,VAS).结果 92例均获得随访,随访时间12～48个月,平均22个月.cage+钛板组及ROI-C融合器组椎间隙高度由术前(47.15±6.96) mm、(46.95±7.14) mm分别增加至术后3个月(79.06±6.67) mm、(78.80±6.85) mm;颈椎Cobb角由术前4.27°±11.15°、2.80°±10.81°分别增加至术后3个月9.29°±12.90°、8.57°±13.00°.ROI-C融合器组较cage+钛板组手术时间短、术中出血量小、术后并发症发生率低,两组差异有统计学意义.末次随访时ROI-C融合器组JOA评分从术前(9.32± 1.74)分增加到(15.15±0.91)分,改善率75.82％± 13.28％;cage+钛板组从术前(9.11±1.23)分增加到(15.29±1.07)分,改善率77.91％±14.14％.两组改善率的差异无统计学差异.两组的颈痛及上肢痛VAS评分均较术前明显降低,但组间比较差异无统计学意义.结论应用ROI-C双嵌片自锁融合器与普通cage+钛板融合的颈前路减压融合术治疗多节段脊髓型颈椎病疗效相当,而采用ROI-C双嵌片自锁融合器固定具有手术时间短、出血少、创伤小、并发症发生率低等优点.
목적 탐토ROI-C쌍감편백쇄융합기재다절단척수형경추병전로감압융합술중적응용효과.방법 2010년3월지2013년9월채용경추전로감압융합술치료다절단척수형경추병92례,남58례,녀34례;년령46～76,평균56.8세.채용보통cage가태판고정(cage+태판조)52례,ROI-C쌍감편자쇄융합기고정(ROI-C융합기조)40례.비교량조환자적술전정황、수술시간、술중출혈량、수술전후추간극고도、경추Cobb각、식골융합솔、병발증발생솔、수술전후일본골과협회(Japanese Orthopedic Association,JOA)평분、경통급상지동통시각모의평분(visual analogue scale,VAS).결과 92례균획득수방,수방시간12～48개월,평균22개월.cage+태판조급ROI-C융합기조추간극고도유술전(47.15±6.96) mm、(46.95±7.14) mm분별증가지술후3개월(79.06±6.67) mm、(78.80±6.85) mm;경추Cobb각유술전4.27°±11.15°、2.80°±10.81°분별증가지술후3개월9.29°±12.90°、8.57°±13.00°.ROI-C융합기조교cage+태판조수술시간단、술중출혈량소、술후병발증발생솔저,량조차이유통계학의의.말차수방시ROI-C융합기조JOA평분종술전(9.32± 1.74)분증가도(15.15±0.91)분,개선솔75.82％± 13.28％;cage+태판조종술전(9.11±1.23)분증가도(15.29±1.07)분,개선솔77.91％±14.14％.량조개선솔적차이무통계학차이.량조적경통급상지통VAS평분균교술전명현강저,단조간비교차이무통계학의의.결론 응용ROI-C쌍감편자쇄융합기여보통cage+태판융합적경전로감압융합술치료다절단척수형경추병료효상당,이채용ROI-C쌍감편자쇄융합기고정구유수술시간단、출혈소、창상소、병발증발생솔저등우점.
Objective To compare the clinical effects of ROI-C self-locking fusion cage and common cage+titanium plate fixation on treatment of multi-segment anterior decompression and fusion for cervical spondylotic myelopathy.Methods From March 2010 to September 2013,92 patients with multi-segment cervical spondylotic myelopathy were treated with anterior decompression and fusion.52 patients were treated with common cage plus titanium plate fixation,while 40 patients were treated with ROI-C self-locking fusion cage.Clinic data including clinical preoperative condition,operation time,intraoperative blood loss,intervertebral space height,Cobb angle of cervical spine,bone graft fusion rate,complications,and JOA score and VAS score were compared.Results Follow-up visit was conducted for all cases,with the time of 12-48 months (22 months on the average).The neurologic symptoms of patients in two groups were relieved obviously after postoperative 1 week,including chest and abdomen constriction feeling,finger pain,finger and lower limb activities.Intervertebral space height of cage +titanium plate group and ROI-C fusion cage group increased to 79.06±6.67 mm and 78.80±6.85 mm respectively after postoperative 3 months from preoperative 47.15±6.96 mm and 46.95±7.14 mm;the Cobb angle increased to 9.29°±12.90° and 8.57°±13.00° respectively after postoperative 3 months from preoperative 4.27°±11.15° and 2.80°±10.81°.In ROI-C group,the operation time,intraoperative blood loss and postoperative complications were significantly lower than those in cage+titanium plate group.The differences of two groups have statistical significance.In the last follow-up visit,JOA score of ROI-C group increased to 15.15±0.91 from preoperative 9.32±1.74,with the improvement rate of 75.82％±13.28％;JOA score of cage + titanium plate group increased to 15.29± 1.07 from preoperative 9.11 ± 1.23,with the improvement rate of 77.91％± 14.14％.The differences of two groups in the improvement rate have no statistical significance.Conclusion Curative effects of ROI-C self-locking fusion cage and common cage+titanium plate fixation on treatment of muhi-segment anterior decompression and fusion for cervical spondylotic myelopathy are similar,while ROI-C self-locking fusion cage has such advantages as short operation time,less blood loss,little injury and low complication incidence.