颈前路零切迹与钢板椎间融合系统治疗单节段脊髓型颈椎病疗效比较

目的 比较颈前路零切迹椎间融合系统(Zero-P)和颈前路钢板椎间融合系统(PCB)治疗单节段脊髓型颈椎病的疗效。方法 采用前瞻性随机对照试验方法对2012年8月—2014年10月63例前路手术治疗的单节段脊髓型颈椎病患者进行研究。63例患者按随机数字表法分为Zero-P组(32例)和PCB组(31例)分别行Zero-P和PCB治疗。观察两组手术时间、术中失血、椎间高度、颈椎Cobb角、JOA评分、颈椎功能障碍指数(NDI)和远期并发症,远期并发症包括螺钉位置丢失、吞咽困难和骨性融合不佳。结果 Zero-P组中1例因随访丢失予以剔除,最终每组均有31例研究对象。两组患者性别、年龄、手术节段、椎间高度、颈椎Cobb角、JOA评分、NDI评分差异均无统计学意义(P值均>0.05)。病例随访时间均大于12个月,Zero-P系统组随访时间(15.52±1.93)个月;PCB组随访(16.10±2.33)个月,差异无统计学意义(t=1.069,P>0.05)。Zero-P组、PCB组手术时间分别为(63.45±10.87)、(85.97±12.04)min,术中出血量分别为(44.35±11.53)、(66.26±19.62)mL,差异均有统计学意义(t=7.730、5.358,P值均<0.01)。两组患者手术后及末次随访时的恢复椎间高度、颈椎Cobb角较术前明显改善,差异均有统计学意义(P值均＜0.05);两组间在手术后和末次随访时,恢复椎间高度、颈椎Cobb角水平差异均无统计意义(P值均>0.05),但在末次随访时PCB组在术后维持Cobb角方面更有优势(P＜0.05)。末次随访时两组JOA评分、NDI评分均较术前明显改善(P值均＜0.05),Zero-P组的NDI评分改善程度优于PCB组(P＜0.01)。至末次随访,两组病例均获骨性融合,其中PCB组出现2例螺钉位置丢失、3例吞咽困难,远期并发症方面Zero-P组优于PCB组(P＜0.05)。结论 Zero-P和PCB在治疗单节段脊髓型颈椎病均可获得较满意的治疗效果。Zero-P组具有手术较简易、颈椎功能保留多、螺钉位置丢失和吞咽困难的相关的远期并发症发生率较低的优点。而较之Zero-P,PCB能够更好地维持颈椎术后生理曲度。

Zero-profile interbody fusion device versus plate cage benezech in the treatment of single-level cervical spondylotic myelopathy

Objective To compare the effectiveness between Zero-profile interbody fusion device(Zero-P) and plate cage benezech(PCB) in the treatment of single-level cervical spondylotic myelopathy. Methods From August 2012 to October 2014, 63 patients were divided into two groups of Zero-P(32 patients) and PCB(31 patients) by the prospective randomized method. Operative time, intraoperative blood loss, intervertebral height, cervical Cobb angle, Japanese Orthopedic Association(JOA) score, neck disability index (NDI) and long-term complications, which contained loss of screw position, dysphagia and unfusion. Results One patient in Zero-P group was lost during the follow-up, so finally 31 patients were in each group. General information of the two groups was comparable (all P values>0.05). All patients follow-up time was more than 12 months. Zero-P′s follow-up time was (15.52 ± 1. 93) months and PCB′s was (16.10 ± 2.33) months (P>0.05). Operative time and blood loss (63.45±10.87) min; (44.35±11.53) mL] of Zero-P group were significantly less than those (85.97±12.04) min, (66.26±19.62) mL] of PCB group (t=7.730, 5.358, all P values<0.01). Compared with the preoperative, the postoperative and last follow-up intervertebral height, cervical Cobb angle in the two groups could get good improvements (all P values<0.05), and the postoperative and last follow-up′s in the two groups had no significant difference (P>0.05). What′s more, the PCB group in maintaining postoperative cervical Cobb angle was better (P<0.05). At the last follow-up JOA score, NDI in two groups were significantly improved (all P values<0.05), and the improvement of NDI in Zero-P group was better than PCB group (P<0.01). At the last follow-up, all patients had bone fusion, but in PCB group there were two cases of screw position lost and three cases of dysphagia. Zero-P group was better in long-term complications(P< 0.05). Conclusions Both Zero-P and PCB could achieve satisfactory clinical effects in the treatment of single-level cervical spondylotic myelopathy. Zero-P group has the advantages of easy operation, short operative time, good improvement of NDI and less incidence of long-term complications, but PCB is better in maintaining cervical postoperative Cobb angle.