CAJ | 학술논문

目的对比颈前路脊髓减压后应用钉板系统与零切迹椎间融合器(Zero-P)治疗脊髓型颈椎病的临床效果.方法 2010年10月至2013年5月,按纳入及排除标准共47例单或双节段脊髓型颈椎病患者入组进行前瞻性随机对照研究.随机分为钉板组(颈前路椎间盘切除减压,融合器植入、钉板系统内固定术,26例)和零切迹组(颈前路椎间盘切除减压,零切迹椎间融合器椎间固定融合术,21例).记录两组手术时间、术中出血量、术后引流量、术后吞咽不适的发生率及持续时间;手术前后按日本矫形外科学会(Japanese Orthopaedic Association,JOA)评分标准评定神经功能,并计算改善率;颈椎侧位X线片测量颈椎Cobb角,根据术后动力位X线片观察手术间隙有无异常活动,评价术后植骨融合及内固定相关并发症情况.结果钉板组手术时间为(71.2±26.8) min,零切迹组为(53.4±28.6) min,差异有统计学意义.钉板组术中出血量(78.1±46.7) ml,术后引流量(63.3±37.7) ml;零切迹组术中H血量(77.5±50.4) ml,术后引流量(60.7±28.6) ml,差异均无统计学意义.术后3周钉板组5例(19.2％)仍存在吞咽困难、零切迹组0例.所有患者均获得随访,随访时间12～42个月,平均(23±2.16)个月,末次随访时两组神经功能均明显改善,钉板组JOA评分由术前的(8.25±1.23)分增加至末次随访时的(14.28±2.96)分,改善率68.91％±7.9％;零切迹组JOA评分由术前的(8.13±1.58)分增加至末次随访时的(14.32±2.87)分,改善率69.79％±11.2％,差异均无统计学意义.钉板组末次随访颈椎曲度为15.2°±5.7°;零切迹组为18.1°±7.9°,差异有统计学意义.末次随访时所有患者均植骨融合.结论零切迹椎间融合器治疗单或双节段脊髓型颈椎病,与传统的钉板系统相比,可以缩短手术时间、减少术后慢性吞咽不适的发生率,有利于颈椎曲度的维持.
목적 대비경전로척수감압후응용정판계통여령절적추간융합기(Zero-P)치료척수형경추병적림상효과.방법 2010년10월지2013년5월,안납입급배제표준공47례단혹쌍절단척수형경추병환자입조진행전첨성수궤대조연구.수궤분위정판조(경전로추간반절제감압,융합기식입、정판계통내고정술,26례)화령절적조(경전로추간반절제감압,령절적추간융합기추간고정융합술,21례).기록량조수술시간、술중출혈량、술후인류량、술후탄인불괄적발생솔급지속시간;수술전후안일본교형외과학회(Japanese Orthopaedic Association,JOA)평분표준평정신경공능,병계산개선솔;경추측위X선편측량경추Cobb각,근거술후동력위X선편관찰수술간극유무이상활동,평개술후식골융합급내고정상관병발증정황.결과 정판조수술시간위(71.2±26.8) min,령절적조위(53.4±28.6) min,차이유통계학의의.정판조술중출혈량(78.1±46.7) ml,술후인류량(63.3±37.7) ml;령절적조술중H혈량(77.5±50.4) ml,술후인류량(60.7±28.6) ml,차이균무통계학의의.술후3주정판조5례(19.2％)잉존재탄인곤난、령절적조0례.소유환자균획득수방,수방시간12～42개월,평균(23±2.16)개월,말차수방시량조신경공능균명현개선,정판조JOA평분유술전적(8.25±1.23)분증가지말차수방시적(14.28±2.96)분,개선솔68.91％±7.9％;령절적조JOA평분유술전적(8.13±1.58)분증가지말차수방시적(14.32±2.87)분,개선솔69.79％±11.2％,차이균무통계학의의.정판조말차수방경추곡도위15.2°±5.7°;령절적조위18.1°±7.9°,차이유통계학의의.말차수방시소유환자균식골융합.결론 령절적추간융합기치료단혹쌍절단척수형경추병,여전통적정판계통상비,가이축단수술시간、감소술후만성탄인불괄적발생솔,유리우경추곡도적유지.
Objective Compare the clinical efficacy between anterior cervical decompressions, internal fixation with steel plate and zero profile interbody fusion system (Zero-P) in the treatment of cervical spondylotic myelopathy.Methods From October 2010 to May 2013, a total of 47 patients with cervical myelopathy were included in prospective randomized controlled study.All patients were randomly divided into two groups, respectively using plate fixation (screw plate system group, 26 cases)and Zero-P (Zero-P group, 21 cases).Compared operation time, intraoperative blood loss, postoperation flow and the incidence of postoperative discomfort swallowing.Evaluated the Japanese Orthopaedic Association (JOA) score of nerve function and calculated improvement rate;measured cervical Cobb Angle on X-ray film, observed abnormal activity of surgical clearance, evaluated degree of bone graft fusion and related internal fixation complications.Results The average operation time of screw plate system group was 71.2±26.8 min, which was 53.4±28.6 min in Zero-P group, significant difference was found in two groups.The average bleeding volume was 78.1 ±46.7 ml, and average volume of postoperation drainage was 63.3±37.7 ml in screw plate system group;the average bleeding volume was 77.5±50.4 ml, and the average volume of postoperation drainage was 60.7±28.6 ml in Zcro-P group, no significant difference was found.5 cases in screw plate system group remained swallowing discomfort 3 weeks after operation, but non in Zero-P group.Followed-up lasted for 24-42 months, an average of 23±2.16 months, nerve function were significantly improved at the end of the follow-up of both two groups, the JOA score of screw plate system group was 14.28±2.96, the improvement rate was 68.91％±7.9％, and Zero-P group was 14.32±2.87, the improvement rate was 69.79％±11.2％, there were no significant difference;curvature of cervical vertebrae of screw plate system group was 15.2°±5.7° at the end of follow-up;Zero-P group was 18.1°±7.9°, which with significant difference.Bone graft fusion were found in all patients at the end of follow-up, and no abnormal activities and fixation loosening was found during follow-up period.Conclusion Zero-P compared with traditional fracture-fixation techniques in treating single or double segments of cervical spondylotic myelopathy, can shorten operation time, reduce the incidence of postoperative chronic discomfort swallowing, and maintain in favour of cervical curvature.