颈前路短节段自体骨融合治疗颈椎病的前瞻性研究

目的探讨颈椎前路椎间短节段自体骨融合治疗颈椎病附加内固定的必要性。方法将81例需行颈前路短节段自体骨融合手术治疗的颈椎病患者随机分为单纯植骨及附加钛板内固定两组,随访55例患者,单纯植骨组23例,内固定组32例。随访时间(22±7)个月。采用JOA评分判定手术疗效, X线片判定融合效果、椎间高度变化和颈椎生理曲度变化。结果JOA评分改善率单纯植骨组68%,内固定组58% (P>0 05)。植骨融合率单纯植骨组93% ( 27 /29 ),内固定组100%。椎间高度单纯植骨组下降(0 7±1 0)mm,内固定组增加( 1 2±0 6 )mm (P<0 01 )。颈椎生理曲度单纯植骨组术后较术前减少(0 5±3 2)°, 内固定组术后较术前增加(2 7±7 8)°(P>0 05)。结论颈椎前路椎间短节段自体骨融合附加内固定治疗颈椎病有一定意义。

A prospective randomized comparison between with or without instrumentation in short-level anterior discectomy and autograft bone fusion

OBJECTIVE: To evaluate anterior cervical plating in short-level anterior discectomy and autograft bone fusion. METHODS: Eighty-one patients who underwent one- and two-level anterior cervical discectomy and fusion were randomized to 2 groups, with or without instrumentation. Among them, 55 patients were followed up. The mean follow-up time was (22 +/- 7) months. Fusion rate, disc height and cervical lordotic alignment were assessed by radiographs. RESULTS: The improving rates were 68% in non-instrumented group and 58% in instrumented group, respectively (P > 0.05). The fusion rate was 93% in the non-instrumented group and 100% in the later one. The disc height was decreased (0.7 +/- 1.0) mm in the former group and increased (1.2 +/- 0.6) mm in the later one (P < 0.01). Although the postoperative cervical lordotic alignment was maintained better in instrumented group, the difference was not significant. CONCLUSION: Anterior cervical plating can make good influence on the result of anterior cervical discectomy and fusion in some degree.