颈前路减压零切迹椎间融合器与传统钛板固定融合术后相邻节段退变的比较

目的 :比较颈前路减压零切迹椎间融合器(Zero-P)与传统钛板内固定融合术治疗单/双节段脊髓型颈椎病对术后相邻节段退变的影响。方法:回顾性分析2015年1月～2018年3月采用颈前路减压Zero-P与传统钛板内固定融合术治疗的113例脊髓型颈椎病患者的资料,其中Zero-P组(A组)65例,传统钛板组(B组)48例,A组再分为单节段组(n=44)和双节段组(n=21),B组再分为单节段组(n=28)和双节段组(n=20),4组患者年龄、性别构成比、手术节段均无统计学差异(P>0.05)。比较两种术式的手术时间、术中出血量,以及4组的术前、末次随访时的日本骨科协会(Japanese Orthopaedie Association,JOA)评分、疼痛视觉模拟评分(visual analog scale,VAS),末次随访时评估患者术后是否出现吞咽困难,并在颈椎侧位X线片上测量术前、术后即刻、末次随访时相邻节段椎间隙高度,评估术前、末次随访时的相邻椎体骨化情况,在颈椎MRI上应用椎间盘Pfirrmann分级评估术前、末次随访时的相邻节段椎间盘退变情况。结果:单节段A组随访时间为18....

Comparison of adjacent segment degeneration after anterior cervical decompression and fusion between Zero-profile interbody fusion device and traditional titanium plate fixation and fusion

Objectives:To compare the effects after anterior cervical decompression and fusion between Ze-ro-profile interbody fusion device(Zero-P)and traditional titanium plate fixation and fusion for single/double segment spinal cervical spondylosis on adjacent segment degeneration.Methods:This article retrospectively analyzed 113 patients with cervical spondylotic myelopathy from January 2015 to March 2018 who were treated by using Zero-P(group A,n=65;single-segment of group A,n=44;double-segment of group A,n=21)and traditional titanium plate fixation and fusion(group B,n=48;single-segment of group B,n=28;double-segment of group B,n=20).This article compares the operation time and intraoperative bleeding of the two operation methods.Comparison of JOA score and VAS score in 4 groups of patients were carried out before surgery and at final follow-up.The patients were assessed for dysphagia at final follow-up.Lateral cervical X-ray films were used to measure the height of the intervertebral space of adjacent segments at preoperative,postoperative and the final follow-up,and to evaluate the ossification of adjacent vertebrae before and after the follow-up.On the cervical spine MRI,Pfirrmann classification of the intervertebral disc was used to evaluate the degeneration of intervertebral discs in the adjacent segments before surgery and at the final follow-up.Results:The average follow-up time for single-segment group A,single-segment group B,double-segment group A,and double-segment group B groups were 18.0±7.9 months,15.8±8.8 months,14.8±6.4 months,and 15.8±8.2 months respectively.The operation time of group A was significantly shorter than that of group B(P<0.05).There was no significant difference in intraoperative blood loss between the two groups(P>0.05).The JOA score and VAS score of the four groups of patients were significantly improved at final follow-up compared with those before surgery.No significant difference in JOA improvement rate between the same segment groups(P>0.05).No significant difference in VAS scores between the same segment groups at final follow-up(P>0.05).At final follow-up,the height of the upper and lower adjacent intervertebral space of group B was significantly lower than that before and after surgery(P<0.05).At final follow-up of the other three groups,the height of the upper and lower adjacent intervertebral space was not significantly different than before and after surgery(P>0.05).At final follow-up,the height of the upper adjacent intervertebral space of the doublesegment group B was significantly lower than that in the double-segment group A and the height of the lower adjacent intervertebral space of the double-segment group B was significantly lower than that in the doublesegment group A(P<0.05).There was no significant difference in the height of the upper and lower adjacent intervertebral spaces between single segment group A and single segment group B at final follow-up(P>0.05).At final follow-up,for the incidence of ossification of adjacent vertebrae,the single-segment group B(32.14%)was higher than the single-segment group A(6.82%)and the double-segment group B(40%)was higher than the double-segment group A(9.52%)(P<0.05).According to the Pfirrmann classification,the double-segment group B(30%)was more prone to adjacent segmental disc degeneration than the double-segment group A(4.76%)(P<0.05).There was no significant difference in degeneration of intervertebral disc between singlesegment group A and single-segment group B at final follow-up(P>0.05).The double-segment group B(30%)was more prone to adjacent segmental disc degeneration than the single-segment group B(7.14%)(P<0.05).There was no significant difference in degeneration of intervertebral disc between single-segment group A and double-segment group A at final follow-up(P>0.05).Regardless of single or double segment,group B had a higher incidence of postoperative dysphagia than group A.Conclusions:In the single-segment and doublesegment of ACDF,Zero-P and traditional titanium plate fusion can achieve similar clinical effects,but Zero-P has advantage to reduce degeneration of adjacent segment and has more obvious advantage in the comparison of the two segments.