CAJ | 학술논문

目的探讨老年患者短节段颈椎病应用零切迹椎间融合器(Zero-P)的疗效,并与传统钛板螺钉加椎间融合器的手术方法之疗效进行比较分析. 方法回顾性分析自2009年6月至2014年3月期间在我院行颈椎前路减压椎间融合手术的老年短节段颈椎病患者.应用零切迹椎间融合器的49例患者纳入实验组(Zero-P组),应用钛板螺钉加椎间融合器(ACDFP)的60例患者纳入对照组(ACDFP组).记录所有患者的手术时间,手术出血量,术前的颈椎功能障碍评分(NDI评分),术前术后颈椎Cobb角和手术节段颈椎Cobb角,计算术后1年时的融合率,根据Bazaz吞咽困难评分对患者术后吞咽困难情况进行评估. 结果两组的平均手术时间、平均手术出血量比较差异无统计学意义(P＞0.05).两组术后NDI评分较术前均降低,组内比较差异有统计学意义(P＜0.05),组间比较差异无统计学意义(P＞0.05).两组颈椎Cobb角(Cobb C)术后第1天复查时均较术前有小幅度改善,术后3个月复查时明显改善.术后3个月复查两组Cobb S均减小,Zero-P组减小更为明显(P＜0.01).术后1年Zero-P组融合数为46例,ACDFP组为56例,差异无统计学意义(x2=0.08,P＞0.05). 结论零切迹椎间融合器在老年患者颈椎前路手术中的疗效与传统的钛板螺钉加椎间融合器手术效果相似,但其手术中显露范围小、出血少,适合应用于老年颈椎病患者.
목적 탐토노년환자단절단경추병응용령절적추간융합기(Zero-P)적료효,병여전통태판라정가추간융합기적수술방법지료효진행비교분석. 방법 회고성분석자2009년6월지2014년3월기간재아원행경추전로감압추간융합수술적노년단절단경추병환자.응용령절적추간융합기적49례환자납입실험조(Zero-P조),응용태판라정가추간융합기(ACDFP)적60례환자납입대조조(ACDFP조).기록소유환자적수술시간,수술출혈량,술전적경추공능장애평분(NDI평분),술전술후경추Cobb각화수술절단경추Cobb각,계산술후1년시적융합솔,근거Bazaz탄인곤난평분대환자술후탄인곤난정황진행평고. 결과 량조적평균수술시간、평균수술출혈량비교차이무통계학의의(P＞0.05).량조술후NDI평분교술전균강저,조내비교차이유통계학의의(P＜0.05),조간비교차이무통계학의의(P＞0.05).량조경추Cobb각(Cobb C)술후제1천복사시균교술전유소폭도개선,술후3개월복사시명현개선.술후3개월복사량조Cobb S균감소,Zero-P조감소경위명현(P＜0.01).술후1년Zero-P조융합수위46례,ACDFP조위56례,차이무통계학의의(x2=0.08,P＞0.05). 결론 령절적추간융합기재노년환자경추전로수술중적료효여전통적태판라정가추간융합기수술효과상사,단기수술중현로범위소、출혈소,괄합응용우노년경추병환자.
Objective To investigate the clinical effect of Zero-profile anterior cervical interbody fusion on single-segment cervical spondylosis in the elderly, and to compare with the effect of traditional anterior cervical decompression and fusion (ACDF) with titanium plate.Methods Clinical data of elderly patients who underwent anterior cervical discectomy and fusion operation (one-or two-level) in our department from June 2009 to March 2014 were retrospectively analyzed.The 49 patients who took anterior cervical interbody fusion with the Zero-profile cage were considered as the Zero-P group, and the other 60 patients who received ACDF with titanium plate as control (ACDFP group).The operation time, blood loss, Neck Disability Index (NDI) score before and after operation, Cobb angle of the cervical spine and Cobb angle of the operated segment before and after operation, the fusion rate 1 year after operation, the dysphagia rate after operation according to Bazaz index were recorded and assessed.Results The operation time and blood loss had no statistical difference between the two group (P＞0.05 for both).The NDI scores were declined in the two group after operation as compared with before treatment (P＜0.05 for both), while there were no statistical difference in NDI score between the two groups (P＞0.05).The Cobb angle of cervical spine had little improvement 1 day after operation as compared with before operation, and improved significantly 3 month after operation in the two group.The Cobb angle of operated segment (Cobb S) was reduced 3 months in the two group after operation as compared with before treatment, and the Cobb S was declined much more in Zero-P group than in control group (P＜0.01).There was no statistical difference in the number of patients with successful fusion between the two group (46 cases vs.56 cases, x2 =0.08, P＞ 0.05).Conclusions The clinical effect of Zero-profile anterior cervical interbody fusion is equivalent as the traditional ACDFP.Zero-profile anterior cervical interbody fusion has less exposure and blood loss, which is more suitable for the elderly patients with cervical degenerative disease.