显微镜下减压联合前路Zero-P治疗颈椎病的早期临床疗效分析

目的:探讨前路颈椎显微镜辅助下精准减压联合前路椎间隙Zero-P融合器置入治疗颈椎病的早期临床疗效。方法:回顾性分析2016年6月至2018年1月我院收治的43例颈椎病患者,处理节段共73个;患者均行显微镜辅助颈椎前路减压、髓核切除、Zero-P置入融合内固定术。记录患者手术节段、手术时间,术中失血量及并发症。手术前,术后1个月、3个月、6个月、末次随访时的颈部及上肢疼痛视觉模拟评分(Visual Analogue Scale,VAS)、颈部日本骨科协会评分(Japanese Orthopedic Association,JOA)和颈椎残障功能指数(Neck Disability Index,NDI),并采用配对t检验对不同时间点的评分进行分析,评估临床疗效。并同期行颈椎X线、CT及MRI检查,测量和评估椎间隙高度、颈椎Cobb角的改变情况和邻近节段异位骨化形成(Adjacent Level Ossification Development,ALOD)。结果:所有患者术后均获得随访,随访时间12-18个月,平均(14.9±2.2)个月。平均手术时间(82.2±20.9)min,失血量(91.5±33.7) m L;未发生神经和血管损伤等严重并发症。与术前相比,患者术后1个月、3个月、6个月及末次随访时的VAS评分、JOA评分、NDI评分、椎间隙高度及Cobb角均明显改善,差异有统计学意义(P0.05)。但术后随访时间点比较,差异无统计学意义(P0.05)。术后出现轻度吞咽困难2例,中度和重度吞咽困难各1例。随访期间,所有患者均获椎间骨性融合,未发生Zero-P融合器松动、滑脱或断裂,椎体未出现继发性骨折。结论:显微镜辅助颈椎前路椎间盘切除、Zero-P融合器置入治疗颈椎病,能够精准的去除神经脊髓组织的压迫,术后短期和中期临床疗效良好,同时显微镜下止血、术中出血少;视野清晰、手术安全性高。

Early Clinical Efficacy Analysis of Microsurgical Decompression Combined with Anterior Zero-P in the Treatment of Cervical Spondylosis

ABSTRACT Objective: To evaluate the early clinical effect of anterior cervical decompression assisted by microscope combined with Zero-P fusion device in anterior intervertebral space in the treatment of cervical spondylosis. Methods: From June 2016 to January 2018, 43patients with cervical spondylosis in our hospital were retrospectively studied, with a total of 73 segments. Microscopically assisted anterior cervical decompression, nucleus pulposus removal, zero-p fusion and internal fixation were performed in all patients. Operative segments, operative time, intraoperative blood loss and complications were recorded. Additionally, the Visual analogue scale (VAS), Japanese orthopaedic association score (JOA) and cervical disability function index (NDI) before operation, 1 month, 3 months, 6 months and the last follow-up after operation were used to evaluate the clinical efficacy. Paired t test was used to analyze the scores at different time points.Meanwhile, cervical X-ray, CT and MRI examinations were performed simultaneously to measure and evaluate the height of intervertebral space, changes of cervical Cobb Angle and Adjacent segmental Ossification Development(ALOD). Results: All patients were followed up postoperatively for 12-18 months, with(14.9±2.2) months on average. with operation time of(82.2±20.9) min on average, and blood loss of(91.5±33.7) mL. No serious complications such as nerve and blood vessel injury occurred.VAS score, JOA score, NDI score, intervertebral height and Cobb Angle of the patients at 1, 3, 6 months after operation and the last follow-up were significantly improved compared with those before operation, and the differences were statistically significant(P<0.05). However, there were no statistically significant relationship between eachpoint(P>0.05). Mild dysphagia occurred in 2 cases, moderate dysphagia and severe dysphagia in 1 case respectively. During the follow-up period, all patients were provided with intervertebral osseous fusion without any loosening, slipping or fracture of zero-p fusion cage or secondary vertebral fracture. Conclusion: The anterior cervical discectomy assisted by the microscope and the zero-p fusion device implantation for the treatment of cervical spondylosis can accurately remove the compression of the neurospinal cord tissue, with good clinical efficacy in the short and medium term after the operation, as well as hemostasis under the microscope and less intraoperative bleeding.Clear vision and high safety.