零切迹椎间融合器与传统钛板笼架治疗退行性颈椎病

[目的]比较零切迹椎间融合器(Zero-P)与传统钛板Cage治疗退行性颈椎病的疗效。[方法]检索Pubmed、web of science、Medline、Cochrane library等数据库自建库至2018年11月份的文献,收集所有零切迹椎间融合器与传统钛板Cage治疗退行性颈椎病的临床对照研究文献,筛选出符合的文章,进行质量评价,提取文献数据并录入Revman 5.3软件行荟萃分析。[结果]共纳入文献14篇,研究对象1 011例,其中Zero-P组481例,传统钛板Cage组530例。荟萃分析结果示:Zero-P组与传统钛板Cage组相比在术中出血量(WMD=-4.55, 95%CI-6.87～-2.22, Z=3.83,P0.001),术后邻近节段退变率(OR=0.42,95%CI 0.23～2.78,Z=2.73,P=0.006),术后椎前软组织厚度(OR=-0.89,95%CI-1.40～-0.38,Z=3.43,P=0.006),术后早期吞咽困难(OR=0.55,95%CI 0.41～0.74,Z=4.05,P0.001),术后终末随访吞咽困难(OR=0.16,95%CI 0.07～0.36,Z=4.53,P0.001)方面差异有统计学意义。[结论] Zero-p组在降低术中出血量、邻近节段退变率、术后椎前软组织厚度、术后早期及终末随访吞咽困难发生率方面优于传统Cage组。     

前路减压Zero-p椎间融合器与传统钛板联合cage融合内固定治疗脊髓型颈椎病的疗效比较

目的:比较前路减压Zero-p椎间融合器与传统钛板联合cage融合内固定治疗脊髓型颈椎病的临床疗效.方法:回顾性分析我院2010年1月～2011年10月采用前路减压植骨融合内固定治疗的46例单节段脊髓型颈椎病患者的临床资料,其中使用Zero-p椎间融合器植骨融合内固定22例(A组,n=22),使用传统钛板联合cage植骨融合内固定24例(B组),两组患者年龄、性别比、术前JOA评分、手术节段分布均无统计学差异,比较两组患者术中出血量、手术时间、术后JOA评分及JOA改善率、融合率、吞咽困难发生率和邻近节段退变率.结果:A组手术时间为97.3min,术中出血量86.4ml;B组为103.5min 、90.6ml,两组比较无统计学差异(P＞0.05).A组1例术后发生吞咽困难,B组8例术后发生吞咽困难,两组吞咽困难发生率有统计学差异(P＜0.05).A组术后随访12～31个月,平均21.5个月,B组术后随访13～32个月,平均22.1个月,两组随访时间无统计学差异(P＞0.05);两组术后JOA评分与术前比较均有统计学差异(P＜0.01),A组JOA改善率为61％,B组为63％,两组比较无统计学差异(P＞0.05).两组融合节段均获得骨性融合,A组44个邻近节段有4个节段椎间盘信号发生退变或退变级别加重,B组48个邻近节段有8个节段椎间盘信号发生退变或退变级别加重,两组融合率和邻近节段退变率均无统计学差异(P＞0.05).结论:应用Zero-p椎间融合器和传统钛板联合cage植骨融合内固定治疗单节段脊髓型颈椎病均可取得较好的疗效,但应用Zero-p椎间融合器术后吞咽困难发生率较低.     

颈椎前路减压椎间融合器或自体骨植骨融合治疗颈椎病的Meta分析

目的:系统评价颈椎前路减压椎间融合器(cage)或自体骨植骨融合治疗颈椎病的疗效。方法:计算机检索MEDLINE、EMBASE、Cochrane CENTRAL(First Quarter 2011)、ScienceDirect、OVID、SpringerLink、中国生物医学文献数据库7个数据库(时间截至2011年6月),手工检索Spine、Euro Spine、JBJS、中华骨科、中国脊柱脊髓等相关杂志,纳入关于颈椎前路减压椎间融合器或自体骨植骨融合治疗颈椎病的RCT研究,评价纳入研究的方法学质量。利用RevMan5.1.1(下载于Cochrane Library)进行Meta分析。选取平均手术时间、失血量、住院时间、并发症发生率、融合率、优良率、取骨处疼痛等指标进行比较。结果:经过筛选,11篇研究符合纳入标准,共1139个病例。纳入研究的质量评价等级均较高(A级10个,B级1个)。Meta分析结果显示:颈椎椎间融合器(cage)融合组与自体骨植骨融合组比较,前者平均术中失血量少于后者[MD=-8.42,95%CI(-15.59,-1.25),P=0.02],平均住院时间短于后者[MD=-0.31,95%CI(-0.62,-0.01),P=0.05],术后并发症发生率小于后者[OR=0.56,95%CI(0.37,0.83),P=0.004],取骨处疼痛二者间存在统计学差异[OR=0.06,95%CI(0.01,0.27),P=0.0002];平均手术时间[MD=-14.55,95%CI(-30.79,1.69),P=0.08]、融合率[OR=1.44,95%CI(0.70,2.96),P=0.32]、优良率[OR=1.39,95%CI(0.92,2.09),P=0.12],两种融合方式之间差异无统计学意义。结论:颈椎椎间融合器(Cage)与自体骨植骨融合治疗颈椎病都取得了良好的疗效。应用cage行椎间融合可以减少术中出血量,缩短住院时间,减少并发症尤其是取骨处疼痛的发生,并且在平均手术时间、融合率、优良率等方面与自体骨植骨融合效果相同。     

零切迹椎间融合器与钛板-椎间融合器系统对颈前路术后颈椎曲度维持的临床研究

目的探讨零切迹椎间融合器与钛板-椎间融合器(plate-cage construct,PCC)系统在颈椎前路术后颈椎曲度维持方面的差异。方法回顾分析2015年1月—2016年1月收治并行颈前路椎间盘切除减压融合术治疗的100例单节段颈椎间盘突出症患者临床资料,其中50例采用零切迹椎间融合器(A组),50例采用PCC系统(B组)。两组患者性别、年龄、骨密度、病变节段、病程及术前疼痛视觉模拟评分(VAS)、日本骨科协会(JOA)评分、C2~7颈椎曲度、节段Cobb角、相邻椎体高度等一般资料比较,差异均无统计学意义(P>0.05),具有可比性。记录两组手术时间及术中出血量;采用VAS评分和JOA评分评估临床疗效;于侧位X线片测量C2~7颈椎曲度、节段Cobb角和相邻椎体高度,根据Pitzen等椎间融合标准评估椎间融合情况。结果A组手术时间显著短于B组(t=2.442,P=0.021),但两组术中出血量差异无统计学意义(t=0.812,P=0.403)。两组患者均获随访,随访时间24~36个月,平均28.5个月。根据Pitzen等的椎间融合标准,两组均达骨性融合。两组内术后1、24个月VAS评分、JOA评分及C2~7颈椎曲度、节段Cobb角、相邻椎体高度均较术前显著改善(P<0.05);除A组术后24个月C2~7颈椎曲度、节段Cobb角及相邻椎体高度较术后1个月有明显丢失(P<0.05)外,两组其余疗效评价指标术后两时间点间差异均无统计学意义(P>0.05)。两组术后24个月C2~7颈椎曲度、节段Cobb角、相邻椎体高度差异有统计学意义(P<0.05),其余各时间点疗效评价指标差异均无统计学意义(P>0.05)。结论颈前路术中采用零切迹椎间融合器虽能获得与PCC系统相似疗效、缩短手术时间,但术后椎间隙高度丢失以及继发颈椎曲度改变均大于PCC系统。     

颈椎椎间融合器研究进展

椎间融合器是颈椎椎间植骨融合的首选装置。近年来,椎间融合器不断优化,形状上从开始的螺纹结构到现在的非螺纹梯形和楔形结构,材料上经历了从钛、聚醚醚酮到椎间融合器表面改性、钛/聚醚醚酮复合材料、可吸收材料,设计上从钛板螺钉固定到零切迹方案及应用3D打印技术定制个性化椎间融合器。该文对颈椎椎间融合器研究进展作一综述。     

颈椎钩椎关节融合器初始稳定性生物力学测试

目的测试颈椎钩椎关节融合器的初始稳定性。方法将20具山羊颈椎标本随机分为完整颈椎组、自体髂骨块植入组、钩椎关节融合器植入组、传统椎间融合器植入组四组,采用非破坏弹性法对山羊C_(3～4)节段进行过伸/过屈、左右侧屈以及轴向旋转活动范围(range of motion,ROM)测试。结果钩椎关节融合器组、零切迹融合器对照组在前屈、后伸、左右侧屈、轴向旋转维度上角位移与髂骨块植入组均差异有统计学意义(P0.05);钩椎关节融合器组和零切迹融合器对照组过伸/过屈ROM差异无统计学意义(P0.05),但钩椎关节融合器组左右侧屈ROM和左右旋转ROM略小于零切迹融合器对照组,差异有统计学意义(P0.05)。结论钩椎关节融合器在左右侧屈与轴向旋转方面稳定性略优于传统零切迹椎间融合器,在前屈/后伸方面与传统零切迹椎间融合器稳定性相当。     

两种不同颈前路固定系统治疗双节段脊髓型颈椎病早期临床效果观察

目的比较颈椎前路椎间盘切除减压术(Anterior cervical decompression and fusion operation,ACDF)术中使用ROI-C零切迹自稳型颈椎融合器与钛板联合cage治疗双节段脊髓型颈椎病的临床疗效。方法回顾性分析自2018-01—2019-12诊治的83例双节段脊髓型颈椎病,39例采用ROI-C零切迹自稳型颈椎融合器行ACDF术治疗(观察组),44例采用钛板联合cage行ACDF术治疗(对照组),比较2组手术时间、术中出血量、术后吞咽困难数以及术后3 d疼痛VAS评分、JOA评分、颈椎Cobb角。结果 83例均顺利完成手术并获得随访,随访时间3~23个月,平均15.2个月。观察组手术时间较对照组少,术后出现吞咽困难数较对照组少,差异有统计学意义(P<0.05)。2组术中出血量比较差异无统计学意义(P>0.05)。2组术后3 d疼痛VAS评分、JOA评分、颈椎Cobb角比较差异无统计学意义(P>0.05)。结论采用ROI-C零切迹自稳型颈椎融合器行ACDF术治疗双节段脊髓型颈椎病可以取得优良的早期疗效,ROI-C内固定系统为ACDF手术提供了一种可靠的内固定选择方案。     

颈前路减压零切迹融合与钛板联合cage融合术后相邻节段退变的比较

目的比较颈前路减压钛板联合cage植骨融合内固定与零切迹椎间融合治疗单节段颈椎病术后对邻近节段退变的影响。方法回顾性分析自2009-06—2013-05采用颈前路减压钛板联合cage融合内固定(钛板组)及颈前路减压零切迹椎间植骨融合内固定术(零切迹组)治疗的49例颈椎病,钛板组24例,零切迹组25例。比较2组手术时间、术中出血量、NDI指数、JOA评分、Bazaz吞咽困难分级,测量颈椎曲度、相邻椎体角度位移及水平位移。结果 2组手术时间(t=0.789,P=0.347)、术中出血量(t=1.488,P=0.303)比较差异无统计学意义(P0.05)。49例均获得随访24~60个月,平均37.8个月。零切迹组吞咽困难发生例数少于钛板组,差异有统计学意义(χ~2=3.984,P=0.043)。术后6个月、末次随访时的NDI指数及JOA评分均较术前明显改善,差异有统计学意义(P0.05)。2组术后6个月及末次随访时颈椎曲度比较差异无统计学意义(P0.05);但钛板组术后6个月及末次随访时角度位移和水平位移均大于零切迹组,差异有统计学意义(P0.05)。结论颈前路减压钛板联合cage融合内固定与零切迹融合均能良好地改善临床症状和维持颈椎曲度,在减少吞咽困难、相邻椎体角度位移及水平位移方面,零切迹系统具有一定优势。     

零切迹椎间融合器治疗跨节段脊髓型颈椎病早期临床疗效分析

目的探讨采用零切迹椎间融合器(Zero-P)行前路椎间盘切除减压植骨融合内固定术(anterior cervical discectomy and fusion,ACDF)治疗跨节段脊髓型颈椎病(cervical spondylotic myelopathy,CSM)的临床疗效。方法回顾性分析2016年7月-2018年7月采用零切迹椎间融合器(Zero-P组)和颈前路钢板+Cage治疗的跨节段CSM患者(钢板组)各24例。对两组患者的手术疗效、影像学指标和并发症情况进行分组比较。结果两组患者术后疼痛缓解及神经功能恢复情况基本相同;但术后12个月时,Zero-P组的上下相邻节段椎间盘退变程度明显小于传统组,而传统组在颈椎Cobb角维持方面则具有优势。结论Zero-P治疗跨节段CSM,融合节段椎体高度未明显丢失,虽然颈椎Cobb角变化不及颈前路钢板+Cage,但责任节段上下相邻椎间盘未出现退变征象,保留了一定的颈椎活动度,中短期临床疗效良好。     

颈椎自稳型椎间融合器在颈椎前路减压融合内固定术的应用

目的观察颈椎自稳型椎间融合器在颈椎前路减压融合内固定术(ACDF)的应用效果。方法将26例行单节段ACDF治疗的颈椎病患者分成A、B两组,A组使用颈椎自稳型椎间融合器,B组使用颈椎前路钛板联合颈椎椎间融合器。对两组患者术前和术后3 d、1年、3年、5年颈椎融合节段上下椎体前、后缘高度变化(HAB、HPB)、颈椎曲度改变(D值、Cobb角)进行统计分析。结果患者均获得随访,时间5～6(5. 4±0. 7)年。A、B两组患者术后3 d、1年、3年、5年颈椎融合节段上下椎间隙高度、颈椎曲度较术前明显改善(P0. 05),两组各相同时间点颈椎融合节段上下椎间隙高度、颈椎曲度比较差异无统计学意义(P 0. 05)。结论应用颈椎自稳型椎间融合器可获得较好的近、中期疗效。     

Technique of cervical interbody fusion

A dovetail autogeneic graft is demonstrated for anterior interbody fusion of the cervical spine for degenerated or protruded intervertebral discs. The method is applicable for one or more levels and has been successfully combined with vertebral body resection for metastatic tumors and trauma. The procedure provides secure initial interbody immobilization and prevents interbody collapse. None of the 58 cases had grafts slip from their original position. The union rate has been 100%.     

椎体次全切除与椎间隙减压治疗多节段颈椎病的疗效比较

目的 比较椎体次全切除减压植骨融合术(anterior cervical corpectomy with fusion,ACCF)和经椎间隙减压植骨融合术(anterior cervical discectomy with fusion,ACDF)治疗多节段颈椎病的临床疗效及影像学结果.方法 回顾性分析2002年6月～...     

Increased fusion rates with cervical plating for two-level anterior cervical discectomy and fusion

STUDY DESIGN: A retrospective review of all patients surgically treated with a two-level anterior cervical discectomy and fusion with and without anterior plate fixation by a single surgeon. OBJECTIVES: To compare the clinical and radiographic success of two-level discectomy and the effect of anterior cervical plate fixation. SUMMARY OF BACKGROUND DATA: Prior studies of multisegment fusions have shown decreased fusion rates correlating with the number of increased levels. The use of anterior plates for single-level cervical fusions is controversial. However, their use in multilevel fusions may be warranted because of the increased pseudarthrosis rates. METHODS: Over a 6-year period, 60 patients were treated surgically with a two-level anterior cervical discectomy and fusion by the senior author. Thirty-two patients had cervical plates, and 28 underwent fusions without plates. These patients were followed for an average of 2.7 years. Clinical and radiographic follow-up evaluations were performed. RESULTS: Of the 60 patients, 7 had a pseudarthrosis. The pseudarthrosis rates were 0% for patients with plating and 25% for those with no plating. This difference was statistically significant (P = 0.003). No correlation of pseudarthrosis with gender, age, level of surgery, history of tobacco use, or the presence of prior anterior surgery was found. There was significantly less graft collapse (P = 0.0001) in the patients without plates in whom pseudarthrosis developed (1.4 mm) than in those who had fusions with plates (0.3 mm). The amount of kyphotic deformity of the fused segment was 0.4 degree in patients with plating compared with 4.9 degrees in those without plating who developed a pseudarthrosis (P = 0.0001). CONCLUSIONS: The addition of plate fixation for two-level anterior cervical discectomy and fusion is a safe procedure with no significant increase in complication rates. The pseudarthrosis rates are significantly higher in patients treated without plate fixation. No nonunions occurred in the patients treated with plate fixation. There was significantly less disc space collapse and kyphotic deformity with the plated fusions than with the nonplated fusions, in which a pseudarthrosis developed. The complication rates for plated fusions are extremely low and do not differ from those for nonplated fusions.     

Increased fusion rates with cervical plating for three-level anterior cervical discectomy and fusion

STUDY DESIGN: A retrospective review of all patients surgically treated by a single surgeon with a three-level anterior cervical discectomy and fusion with and without anterior plate fixation. OBJECTIVES: To compare the clinical and radiographic success of anterior three-level discectomy and fusion performed with and without anterior cervical plate fixation. SUMMARY OF BACKGROUND DATA: Previous studies of multilevel cervical discectomies and fusions have shown fusion rates to decrease as the number of surgical levels increases. Anterior cervical plate stabilization can provide more stability and may increase fusion rates for multilevel fusions. METHODS: Over a 7-year period, 59 patients were treated surgically with a three-level anterior cervical discectomy and fusion by the senior author. Forty patients had cervical plates, whereas 19 had fusions with no plates. These patients were observed for an average of 3.2 years. Clinical and radiographic follow-up data were obtained. RESULTS: Of the 59 patients, 14 had a pseudarthrosis (7 in each group). The pseudarthrosis rates were 18% (7 of 40) for patients with plating and 37% (7 of 19) for patients with no plating. Although the nonunion rate for unplated fusions was double that of plated fusions, this difference was not statistically significant. There was no statistically significant correlation between pseudarthrosis and gender, age, level of surgery, history of tobacco use, or previous anterior surgery. The fusion rates were improved with the use of a cervical plate. Inferior clinical results were demonstrated in patients with a pseudarthrosis, regardless of the use of a cervical plate. CONCLUSIONS: The addition of plate fixation for three-level anterior cervical discectomy and fusion is a safe procedure and does not result in higher complication rates. In this study, the pseudarthrosis rate was lower for patients with a cervical plate. However, this difference was not statistically significant. Patients treated with cervical plating had overall better results when compared with those of patients treated without cervical plates. Although the use of cervical plates decreased the pseudarthrosis rate, a three-level procedure is still associated with a high nonunion rate, and other strategies to increase fusion rates should be explored.     

零切迹颈前路椎间融合固定系统在颈前路融合术中的初步应用

目的探讨零切迹颈前路椎间融合固定系统(Zero-p ACIF)在颈椎前路融合术中的应用效果。方法 2009-12-2010-10,对24例(26节段)颈椎疾病患者行前路椎间零切迹椎间融合固定系统内固定,其中颈椎外伤性椎间盘突出、不稳7例,颈椎间盘疾患17例,其中双节段2例。结果24例患者随访12～20个月,平均随访14个月,JOA评分由术前平均8.6分上升到末次随访时15.2分,术后X线片与末次X线片提示椎间高度无丢失,内固定无松动。结论 Zero-p ACIF有较优异的材料和力学性能,能有效维持融合椎间高度,对椎前组织无影响,是一种新的颈前路融合手段。     

Anterior cervical discectomy and fusion

The science of cervical spinal surgery is a constantly developing field. The concept of the anterior approach initially described by Bailey and Badgley² has been modified many times and continues to evolve. Despite all the modifications, two basic anterior procedures are currently performed for treatment of the clinical syndromes resulting from cervical spine degeneration: anterior cervical discectomy with interbody fusion and anterior cervical corpectomy and strut grafting. The following article presents both techniques, their indications, and the possible complications that these techniques may incur. This article also discusses the relative merits of each technique and benefits of anterior versus posterior approach for the treatment of cervical spondylosis.     

生物活性颈椎椎间融合器在颈椎融合术中不同固定方式的生物力学研究

目的 探讨由羟基磷灰石和左旋聚乳酸复合研制的新型生物活性颈椎椎间融合器在颈椎融合术中不同固定方式的生物力学特性.方法 制备新鲜人颈椎标本6个(尸体均为合法捐赠,由南方医科大学解剖学教研室提供),模拟临床术式行前路C5～6减压椎间分别植入髂骨、生物活性颈椎椎间融合器和生物活性颈椎椎间融合器加钢板内固定,通过脊柱三维运动实验机测量C5～6节段的运动范围.结果 生物活性颈椎椎间融合器加钢板固定后稳定性增加,在各个状态的运动范围均明显小于其他各组(P ＜0.005).单纯生物活性颈椎椎间融合器组在后伸状态下运动范围(6.25±0.29)度较正常组(5.76±0.40)度增大,稳定性下降,但差异无统计学意义(P＞0.05);在除后伸外的其他各种状态下的运动范围均小于髂骨组,较髂骨组稳定,差异有统计学意义(P＜0.005).结论 新型生物活性颈椎椎间融合器具有良好的生物力学性能,加钢板内固定后各个方向稳定性好,能重建颈椎稳定性.     

Anterior cervical discectomy and fusion

A retrospective review of 94 patients who had undergone anterior cervical discectomy and fusion was performed to analyze the result in patients who had a diagnosis of posterolateral spondylosis, disc herniation, or both. Although in 23 of 94 patients additional adjacent asymptomatic levels of spondylosis were noted, only the symptomatic levels were addressed in the 94 cases. Postoperatively two cases of dysphagia were noted, as well as a 4% pseudarthrosis rate. There was an 88% good or excellent result when no additional spondylosis was present, but only a 60% good or excellent result when just the symptomatic levels were addressed, leaving unoperated adjacent levels of spondylosis.