颈前路“零切迹”椎间融合器与传统钛板融合器内固定治疗单节段颈椎病的疗效比较
Clinical effects of Zero-P vs. traditional titanium plate for single level cervical spondylosis

摘要：目的 比较颈椎前路Zero-P椎间融合器与传统钛板椎间融合器内固定治疗单节段颈椎病的疗效。方法 回顾分析我院神经外科2012年1月～2014年1月28例单节段颈椎病病例的临床资料，其中16例患者使用传统颈前路钛板联合椎间融合器植骨融合内固定(A组)，12例患者使用颈前路Zero-P椎间融合器植骨融合内固定(B组)，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、NDI评分、吞咽困难发生率以及术后融合节段椎间隙高度和Cobb角的变化。结果 A组手术时间明显长于B组(P<0.01)，术中出血量两组差异无统计学意义(P>0.05)；术后1周吞咽困难发生率B组低于A组；两组JOA评分及JOA改善率在术后相同时间段相比无统计学差异(P>0.05)；两组NDI评分相比，术前及术后12个月无统计学差异(P>0.05)，术后1个月及术后6个月B组明显低于A组(P<0.05)；两组融合节段椎体高度及高度增加率在术后1个月无统计学差异(P>0.05)，术后12个月B组明显大于A组(P<0.05)；两组融合节段Cobb角术后各时间段B组均明显大于A组(P<0.05)；两组C2～C7节段Cobb术后各时间段相比均无统计学差异(P>0.05)。结论 Zero-P椎间融合器与传统钛板椎间融合内固定两种手术方式对于单节段颈椎病均能获得满意的疗效，但Zero-P椎间融合器能降低术后吞咽困难的发生率，并在手术时间、术后颈椎生理结构恢复方面优于传统钛板椎间融合内固定。
ABSTRACT: Objective To compare the clinical effects of Zero-P and traditional titanium plate with cage in treating single level cervical spondylosis. Methods We retrospectively analyzed the clinical data of 28 patients with single level cervical spondylosis who underwent anterior cervical discectomy and fusion (ACDF) by traditional titanium plate with cage (group A, n=16) or Zero-P implant (group B, n=16) in our department between January 2012 and January 2014. The intraoperative blood loss, operation time, postoperative JOA scores, JOA recovery rate, NDI scores, and dysphagia incidence in both groups were measured and compared. The changes of the midpoint interbody height (IBH), the cervical Cobb angle of the surgical segment and the cervical Cobb angle of C2 and C7 vertebral body were measured on the standing lateral cervical spine X-ray. Results The operation time was significantly longer in group A than in group B (P<0.01), but there were no significant differences in intraoperative blood loss between the two groups (P>0.05). The incidence of dysphagia was lower in group B than in group A. The two groups did not significantly differ in JOA score or JOA improvement rate during the same period after operation (P>0.05). The NDI score in group B was significantly lower than that in group A (P<0.05) at 1 month and 6 months after operation, but showed no significant difference in preoperative and 12 months after operation (P>0.05). The midpoint interbody height in group B was significantly greater than that in group A (P<0.05) 12 months after operation, but showed no significant difference one month after operation. The cervical Cobb angle of the surgical segment was significantly greater in group B than in group A (P<0.05) after operation, but there was no significant difference in cervical Cobb angle of C2 and C7 vertebral body between the two groups at various time