颈椎前路椎间盘切除钢板内固定术与融合Zero-p植入的临床对照研究

【摘要】〓目的〓比较前路颈椎椎间盘切除术钢板内固定与Zero-p植入的临床疗效。方法〓选择2009年12月~2013年2月在我院接受颈椎椎间盘切除的134例患者,根据已采取的不同术式分为2组,ACDF组(n=71):行前路椎间盘切除椎间融合(ACD)与钢板内固定;Zero-P组(n=63):行前路椎间盘切除与Zero-P内固定。所有患者均有不同程度的颈肩部疼痛,四肢疼痛麻木及无力感,其中68例有躯干束带感及双下肢踩棉花感,12例伴有轻度大小便功能障碍。分别评估单节段手术时间、术中出血量、手术前后影像学、VAS、JOA、D值及SWAL-QOL评分等。结果〓全部病例均获得随访,随访时间8~24月,平均13±2.5月。ACDF与Zero-p组平均每节段手术时间为65±11.3 min和47±7.6 min,平均每节段出血量为68.5±21.1 mL和42.7±14.4 mL。上述两种比较,Zero-p组均较ACDF组减少,差异有统计学意义(P<0.05)。两组均未见植入物的沉降或塌陷,植入螺钉松动,所有患者的影像学证据显示骨性融合。结论〓Zero-P系统操作简单,手术时间短,术中出血量少,早期临床疗效满意,理论上可有效降低钢板置人所导致的并发症,尤其是减少术后吞咽困难,是前路颈椎钢板内固定的有效替代植入物。

Comparative study between a Zero-profile implant for anterior cervical diskectomy with fusion and anterior cervical discectomy with plate fixation

Objective To compare the clinical efficacy of anterior cervical discectomy with plate fixation （ACD） and Zero-profile implantation （zero-P）. Methods A total of 134 cases were included in the study from December 2009 to February 2013. The patients （ACDF group, n=71） were performed anterior discectomy and interbody fusion with plate internal fixation and those （Zero-P group, n=63） underwent anterior discectomy and Zero-Profile implantation. All patients had different degrees of pain on the neck and shoulder, pain on the limbs and numbness and weakness, of which 68 cases with trunk banding and double lower limbs on cotton, 12 cases with mild defecation dysfunction. Single segment operation time, intraoperative bleeding, pre- and post-operation imaging, VAS, JOA, D value and SWAL-QOL score in two groups were assessed and compared. Results All the cases were followed up for 8-24 months with an average 13±2.5 months. In ACDF and Zero-p group, the operation time of each segment of ACDF and Zero-p group was 65±11.3 min and 47±7.6 min respectively, estimated bleeding loss was 68.5±21.1 ml and 42.7±14.4 ml, hospital stay was 5.4 and 4.2 days. Zero-p group showed a better clinical efficacy when compared with ACD group, and there were significant differences. No implant subsidence or collapse, implant loosening screw were found. Conclusion The model of zero notch implant system has the advantages of simple operation, short operation time, less bleeding and good early clinical effect. The Zero-P implant is a valid alternative to anterior cervical plating after ACDF with a very low incidence of postoperative dysphagia and no implant-related complications.