| 颈前路Zero-P系统与传统钛板联合cage系统治疗多节段颈椎病的病例对照研究 |
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Received:October 17, 2018
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| 作者 | Author | 单位 | Unit | E-Mail |
| 赵磊 |
ZHAO Lei |
南京医科大学附属南京医院骨科 南京市第一医院, 江苏 南京 210006 |
Department of Orthopaedics, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, Jiangsu, China |
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| 祁义民 |
QI Yi-min |
南京医科大学附属南京医院骨科 南京市第一医院, 江苏 南京 210006 |
Department of Orthopaedics, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, Jiangsu, China |
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| 曾逸文 |
ZENG Yi-wen |
南京医科大学附属南京医院骨科 南京市第一医院, 江苏 南京 210006 |
Department of Orthopaedics, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, Jiangsu, China |
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| 王钢锐 |
WANG Gang-rui |
南京医科大学附属南京医院骨科 南京市第一医院, 江苏 南京 210006 |
Department of Orthopaedics, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, Jiangsu, China |
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| 郑圣鼐 |
ZHENG Sheng-nai |
南京医科大学附属南京医院骨科 南京市第一医院, 江苏 南京 210006 |
Department of Orthopaedics, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, Jiangsu, China |
zsn3280@sina.com |
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| 期刊信息：《中国骨伤》2019年32卷，第3期，第212-219页 |
| DOI：10.3969/j.issn.1003-0034.2019.03.004 |
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目的：探讨颈前路零切迹椎间植骨融合内固定系统（zero-profile intervertebral fusion system，Zero-P）和颈前路减压植骨融合内固定术（conventional cage-plate intervertebral fusion system，CCP）应用于颈椎病多节段（≥ 2个节段）减压融合内固定的近期临床疗效。
方法：选取2012年10月至2017年10月因颈椎病行颈椎前路多节段减压融合术的42例作为研究对象。其中Zero-P组21例，CCP组21例。分别记录两组手术一般状况及围术期参数，颈部手术前后VAS、JOA评分及吞咽困难发生率。测量患者在术后1周、1个月及末次随访时的椎前软组织厚度。同时测量融合节段脊柱功能单位Cobb角，观察颈椎整体曲度的改变情况。于术后1周，1、3、12个月追踪临床疗效并复查颈椎正侧位X线片，评价内固定效果。
结果：两组患者年龄、性别、病程、手术节段、平均随访时间及住院日组间差异无统计学意义（P>0.05）。手术切口长度、术中出血量、手术时间、术后引流量Zero-P组分别为（4.37±0.72）cm、（50.9±7.98）ml、（84.4±8.18）min、（76.2±10.13）ml，CCP组分别为（6.50±0.71）cm、（108.6±9.25）ml、（118.6±8.55）min、（130.1±9.42）ml，两组比较差异有统计学意义（P<0.05）。末次随访时VAS评分及JOA改善率两组间差异无统计学意义（P>0.05），颈椎整体生理曲度两组间差异无统计学意义（P>0.05）。术后1周、1个月及末次随访椎前软组织厚度Zero-P组分别为（11.6±1.9）、（9.8±1.4）、（9.5±1.6）mm，CCP组分别为（12.5±2.6）、（11.1±2.4）、（11.0±1.9）mm，两组间各随访时间点椎前软组织厚度差异有统计学意义（P<0.05）。至末次随访时，Zero-P的Zero-P系统均为有效治疗手段，但Zero-P系统具有手术切口小、手术时间短、术中出血少、操作方便的优点，且术后椎前软组织肿胀恢复佳，术后发生吞组无一例诉吞咽困难，CCP组有3例发生吞咽困难，两组间差异有统计学意义（P<0.05）。
结论：在颈椎病多节段减压融合中，不论是传统CCP系统还是新型咽困难的可能性更低。 |
| [关键词]:脊柱融合术 颈椎病 吞咽困难 |
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| Case control study on Zero-profile intervertebral fusion system and conventional cage-plate intervertebral fusion system for the treatment of multi-segment cervical spondylosis |
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Abstract:
Objective:To explore the clinical effect in the near future between Zero-profile intervertebral fusion system (Zero-P) and conventional cage-plate intervertebral fusion system (CCP) for the multi-segment(≥2 segments) cervical spondylosis.
MethodsForty-two patients with cervical spondylosis who underwent multi-segment decompression of the cervical spine from October 2012 to October 2017 were selected as subjects. Zero-P was applied in 21 patients (Zero-P group) and CCP was applied in 21 patients(CCP group). The general condition and perioperative parameters of all the patients were recorded. VAS,JOA scores and incidence of dysphagia were observed before and after operation. The prevertebral soft tissue thickness was measured at 1 week,1 month after operation and at the last follow-up. At the same time,the Cobb angle of the functional unit of the fusion segments was measured,and the overall curvature change of the cervical vertebra was observed. The clinical efficacy was reviewed at 1 week,1,3,12 months after surgery,and the AP and lateral cervical X-rays were reviewed to evaluate the internal fixation effect.
ResultsThere were no significant differences in age,gender,duration of disease,surgical segment,follow-up time and hospitalization time between two groups(P>0.05). The length of the surgical incision,intraoperative blood loss,operation time,postoperative drainage volume in the Zero-P group were(4.37±0.72) cm,(50.9±7.98)ml,(84.4±8.18) min,(76.2±10.13) ml,respectively,and those in CCP group were (6.50±0.71) cm,(108.6±9.25) ml,(118.6±8.55) min,(130.1±9.42) ml,respectively. There were signigicant differences in above items between two groups(P<0.05).There were no significant difference in the VAS and JOA improvement rate between two groups at the last follow-up (P>0.05). There was no significant difference in the overall physiological curvature of the cervical vertebra between two groups (P>0.05). The prevertebral soft tissue thickness at 1 week,1 month after operation,final follow-up respectively was(11.6±1.9),(9.8±1.4),(9.5±1.6) mm in Zero-P group,and in CCP group those were(12.5±2.6),(11.1±2.4),(11.0±1.9) mm,respectively. There were significant differences in each time point between two groups(P<0.05). At the last follow-up,no complication of dysphagia was found in Zero-P group,and three patients had dysphagia in CCP group,with a statistically significant difference between two groups (P<0.05).
ConclusionMultiple segmental decompression fusion to treat cervical spondylosis,regardless of the traditional CCP system or new Zero-P system are effective methods,but the Zero-P system has advantages of small surgical incision,short operation time,less intraoperative bleeding,convenient operation,better recovery of prevertebral soft tissue swelling,and lower possibility of postoperative dysphagia. |
| KEYWORDS:Spinal fusion Cervical spondylosis Dysphagia |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 赵磊,祁义民,曾逸文,王钢锐,郑圣鼐.颈前路Zero-P系统与传统钛板联合cage系统治疗多节段颈椎病的病例对照研究[J].中国骨伤,2019,32(3):212~219 |
| 英文格式: | ZHAO Lei,QI Yi-min,ZENG Yi-wen,WANG Gang-rui,ZHENG Sheng-nai.Case control study on Zero-profile intervertebral fusion system and conventional cage-plate intervertebral fusion system for the treatment of multi-segment cervical spondylosis[J].zhongguo gu shang / China J Orthop Trauma ,2019,32(3):212~219 |
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