微创小切口零切迹颈前路椎间融合器治疗单节段脊髓型颈椎病的疗效评价.doc

微创小切口零切迹颈前路椎间融合器治疗单节段脊髓型颈椎病的疗效评价 廖壮文 黄彦 范子文 黄文铎 广州医学院第二附属医院，骨外科，510260 摘要 目的：探讨新型零切迹颈前路椎间融合器（Zero profile anterior cervical interbody fusion cage,ACIFC)单独应用于单节段脊髓型颈椎病（Cervical Spondylotic Myelopathy，CSM）微创小切口治疗的手术特点和近期临床疗效。方法：对收治的43例中老年单节段CSM患者采用颈椎前路横行小切口，椎间盘髓核摘除、减压、ACIFC单独植入植骨融合内固定术，分析手术特点，对比手术前后、近期末次随访的临床疗效(VAS和JOA评分)及影像学融合节段椎间隙高度、CobbS角变化，判断椎间稳定变化及椎间融合率。结果：手术时间55±10min；术中失血35±10ml。住院时间5.2±1.2天，术后吞咽困难发生率2.3%。术后随访18.5±4.5(13-26)月，43例患者术前VAS评分6.5±1.5分，JOA评分9.2±1.7分，末次随访VAS评分1.2±0.8分，JOA评分15.6±1.8分，JOA评分术后改善率：优23例,良15例,可4例，差0例,优良率90.7%。术后1周和末次随访与术前相比融合节段椎间隙高度和CobbS角度明显改善(P0.01)，术后1周与末次随访比较无明显间隙高度和角度丢失(P0.05)，随访过程中未发现融合器及内固定螺钉松动、移位，末次随访颈椎过屈过伸位X线片判断椎间稳定性率100%，X-ray可判断椎间融合率65.1%（28/43）。结论：ACIFC单独应用于单节段CSM微创小切口治疗的手术创伤小，操作简单，并发症低，住院时间短，达到微创化手术效果，可有效改善和维持颈椎的病变节段生理曲度和间隙高度，有良好的力学稳定性能，临床近期疗效满意。中远期疗效需进一步随访评估。 关键词：脊髓型颈椎病；椎间融合；零切迹颈前路椎间融合器 Effect of Stand-alone Zero profile anterior cervical interbody fusion cage in treating of the single segmental cervical spondylotic myelopathy with anterior mini-incision∥Yan Huang, Ziwen Fan, Wenduo Huang. Department of Orthopedics，the Second Affiliated Hospital of Guangzhou Medical University，Guangzhou,510260，China. Abstract: Objective: To observe the clinical effect of Stand-alone Zero profile anterior cervical interbody fusion cage(ACIFC) in treating of the single segmental cervical spondylotic myelopathy(CSM) with anterior mini-incision and analyze its operative characteristics. Methods: 43 patients with single segmental CSM were treated by anterior decompression, implantation of ACIFC with anterior mini inc ision. Clinical outcome according to VSA and JOA scoring system，lordosis angle of cervical spine and intervertebral space angle and height on radiographs were recorded pre- and post-operatively. Result: All patients were followed up for an average of 18.5±4.5 months(12 to 26 months) and achieved 65.1%（28/43）bone fusion within the follow-up period. The average VAS score decreased from 6.5±1.5 preoperatively to 1.2±0.8 at the final fol