融合与非融合杂交技术在多节段颈椎前路手术中的应用

目的 探讨颈椎病多节段前路减压手术中融合与非融合技术组合使用的应用指证并评价其疗效.方法 2008年1月至2012年1月,采用颈椎前路融合与非融合杂交技术治疗涉及多个节段的颈椎病18 例,其中男11 例,女7 例,年龄28～52 岁,平均36.7 岁.18 例中,脊髓型颈椎病8 例,神经根型颈椎病3 例,混合型颈椎病7 例.非融合间隙均为1个,其中采用Prodisc-C人工椎间盘置换16 例,颈椎动态稳定器2 例.单间隙融合5 例（椎间盘摘除cage植入）,2间隙融合11 例,3间隙融合2 例.术前、术后进行JOA评分和颈椎残障功能量表（neck disability index,NDI）评定,按Odom标准评定治疗效果.结果 18 例患者术后平均随访22.9个月（15～42个月）,所有患者临床症状、脊髓功能改善明显,未出现钛网下沉、假体松动、颈椎反屈、融合节段假关节形成及二次手术.融合节段术后融合时间平均5.2个月（3～9个月）,JOA评分由术前平均9.8分（7～12分）上升至术后平均14.9分（12～17分）.末次随访时JOA评分、NDI评分与术前比较差异有统计学意义（P＜0.05）.按Odom标准评价手术效果,优10 例,良5 例,尚可3 例,优良率83.5%.结论 颈椎病多节段融合手术中选择性组合使用非融合技术,能够减少融合节段,降低长节段融合后邻近节段的应力,为预防邻近节段退变提供了一种可行的方式.

Hybrid Application of Anterior Fusion and Non-fusion Technique for the Multilevel Cervical Spondylosis

Objective To investigate the hybrid application of anterior fusion and non-fusion technique for the multilevel cervical spondylosis and evaluate its efficacy. Methods From January 2008 to January 2012, hybrid technique of anterior cer- vical fusion and non-fusion was performed in 18 cases of multilevel cervical spondylosis. There were 11 males and 7 females, with a mean age of 36.7 （ 28 N 52 years ）. There were 8 cases of cervical spondylotic myelopathy, 3 cases of cervical spondylotic radiculopathy and 7 mixed cervical spondylosis. One segment of non-fusion was applied in all patients（ 16 Prodisc-C artificial disc replacement and 2 dynamic cervical instruments）. One fusion was performed for 5 patients ,two for 11 and three for 2 pa- tients. Preoperative and postoperative JOA score and neck disability index （NDI） were assessed. The outcome was evaluated with the criterion of the Odom. Results 8 patients were followed up with an average of 22.9 months （ 15 ~ 42 months）. The symptoms and spinal cord function improved significantly. There was no sink of mesh, instrument loosing, recurvation, pseudar- throsisand extra surgery. All fusion segments got a bone union at 5.2 （3 ~ 9） months. The JOA score improved from 9.8 （7 ~ 12） preoperatively to 14.6（ 12 N 17） postoperatively. There was significant difference of JOA score and NDI at last follow-up （ P 〈 O. 05 ）. By the Odom criterion, the effect was excellent in 10 cases, good in 5 cases, moderate in 3. The excellent and good rate was 83.3%. Conclusion Hybrid application of anterior fusion and non-fusion technique can reduce the fusion segments for the multi-segmental cervical spondylosis surgery. This can avoid the increased stress of adjacent segment after multi-level fusion and provide a feasible way for the prevention of adjacent segment degeneration.