摘要
目的:分析颈前路减压Zero-P融合固定术后椎间隙高度(intervertebral height,IH)变化对临床疗效和影像学参数的影响。方法:收集2014年5月~2017年12月在我院行颈前路减压Zero-P融合固定术且随访时间1年以上的123例脊髓型和神经根型颈椎病患者的资料。记录术前、术后1周及末次随访时的手术节段IH,并按术后平均IH变化值(术后1周IH与末次随访的差值)将所有患者分为IH维持组(IH变化值<平均IH变化值)和IH丢失组(IH变化值≥平均IH变化值)。比较两组患者的性别、年龄、手术节段,术前、术后1周及末次随访时的日本骨科学会(Japanese Orthopedics Association,JOA)颈椎功能评分、颈痛视觉模拟评分(visual analogue score,VAS)、颈椎功能障碍指数(neck disability index,NDI)、C2-7 Cobb角及手术节段曲度,术后3周内的吞咽困难发生率,术后3个月、6个月及末次随访的融合率及末次随访时的邻近节段退变(adjacent segment degeneration,ASD)发生率。两组间定量变量的差异采用独立样本t检验,定性变量差异进行卡方检验。结果:根据所有患者术后平均IH变化值(2.08±0.94mm),将123例患者分为2组,其中IH维持组64例,随访时间为15.95±3.39个月;IH丢失组59例,随访时间为16.95±2.87个月。两组的性别、年龄、手术节段及随访时间均无统计学差异(P>0.05),术前、术后1周及末次随访时的JOA评分、VAS评分、NDI、C2-7 Cobb角和手术节段曲度两组间比较均无统计学差异(P>0.05),吞咽困难发生率及末次随访时的融合率两组间比较均无统计学差异(P>0.05)。IH维持组术前IH为5.65±1.69mm,术后1周为8.33±0.78mm,末次随访为6.89±0.98mm,平均变化量为1.44±0.79mm;IH丢失组术前IH为5.31±1.58mm,术后1周为8.25±0.76mm,末次随访为5.50±1.01mm,平均变化量为2.75±0.52mm。IH维持组末次随访时IH和IH变化值显著高于IH丢失组(P<0.001)。术后3个月时IH维持组融合率为64.06%,IH丢失组为42.37%(P=0.019);术后6个月时IH维持组融合率为81.25%,IH丢失组为54.24%(P=0.002)。末次随访时IH维持组下邻近节段退变发生率为12.5%,显著低于IH丢失组的28.81%(P=0.027)。IH维持组假体下沉发生率为3.13%,显著低于IH丢失组的13.56%(P=0.047)。结论:颈前路减压Zero-P融合固定术后手术节段IH丢失发生率较高;若IH丢失≥2mm可能会降低术后早期融合率,并增加ASD及假体下沉等并发症的发生率。
Objectives:To analyze the effect of changes in intervertebral height(IH)of surgical level on clinical outcomes and imaging parameters after anterior cervical decompression and fusion with the Zero-Profile implant system(Zero-P).Methods:The data of 123 patients with cervical spondylosis of cervical myelopathy or radiculopathy who underwent anterior cervical decompression and fusion with the Zero-P in our hospital from May 2014 to December 2017 and were followed up for at least 1 year were retrospectively analyzed.The IH of operative segment before surgery,at 1 week after surgery and at final follow-up was recorded,and according to the mean IH change value after surgery(difference between IH at 1 week after surgery and final follow-up)the patients were divided into IH maintaining group(IH change0.05),nor was there significant difference between the two groups in preoperative,postoperative 1 week,and final follow-up JOA scores,VAS,NDI,C2-C7 Cobb angle,or surgical segment curvature(P>0.05).Besides,no significant difference was found in dysphagia incidence or final follow-up fusion rate between the two groups(P>0.05).In the IH maintaining group,the IH was 5.65±1.69mm at preoperation,8.33±0.78mm at 1 week after surgery,and 6.89±0.98mm at the last follow-up,with a mean change of 1.44±0.79mm.In the IH loss group,IH was 5.31±1.58mm preoperatively,8.25±0.76mm 1 week postoperatively,and 5.50±1.01mm at the last follow-up,with a mean change of 2.75±0.52mm.The IH and IH change at the last follow-up were significantly higher in the IH maintaining group than those in the IH loss group(P<0.001).The fusion rate was 64.06%in the IH maintaining group and 42.37%in the IH loss group at 3 months postoperatively(P=0.019),and 81.25%in the IH maintaining group and 54.24%in the IH loss group at 6 months postoperatively(P=0.002).At the final follow-up,the inferior ASD incidence was 12.5%in the IH maintaining group,which was significantly lower than the 28.81%in the IH loss group(P=0.027).In addition,the incidence of implant subsidence was significantly lower in the IH maintaining group(3.13%)than that in the IH loss group(13.56%)(P=0.047).Conclusions:The incidence of IH loss of operative segements after anterior cervical decompression and fusion with Zero-P implant system is high,and the early postoperative fusion rate may decrease and the incidence of complications such as ASD and prosthesis subsidence may increase if IH loss≥2mm.
作者
海米提·阿布都艾尼
刘浩
王贝宇
吴廷奎
洪瑛
孟阳
陈华
HAIMITI Abudouaini;LIU Hao;WANG Beiyu(Department of Orthopedics,West China Hospital,Sichuan University,Chengdu,610041,China)
出处
《中国脊柱脊髓杂志》
CAS
CSCD
北大核心
2022年第11期980-985,共6页
Chinese Journal of Spine and Spinal Cord
作者简介
第一作者:海米提·阿布都艾尼,男(1990-),在读博士研究生,研究方向:脊柱外科,电话:17882085070,E-mail:511134378@qq.com;通讯作者:刘浩,E-mail:liuhao6304@163.com。
