摘要
目的比较研究颈椎前路椎间盘切除术钢板内固定与Zero．P植入的吞咽困难。方法2009年12月～2013年2月，按病例纳入标准选取134例，所有患者均有不同程度的颈肩部疼痛，四肢疼痛麻木及无力感，其中68例有躯干束带感及双下肢踩棉花感，12例伴有轻度大小便功能障碍，随机分为两组。ACDF组71例，行前路椎间盘切除椎间融合与钢板内固定；Zero-P组63例，行前路椎间盘切除与Zero-P内固定。分别比较单节段手术时间、术中出血量、手术前后影像学、VAS、JOA、D值及SWAL-QOL评分等进行评估。结果全部病例均获得随访。随访时间8～24月，平均13±2．5月。ACDF与Zero-P组平均每节段手术时间：（65±11．3）min、（47±7．6）min；平均每节段出血量：（68．5±21．1）ml、（42．7±14．4）ml；平均住院时间5．4d、4．2d。显示：Zero-P组均较ACDF组减少，差异有显著性P〈0．05。两组未见植入物的沉降或塌陷，植入螺钉松动，所有患者的证据表明骨性融合。结论Zero-P内置物系统操作简单，手术时间短，术中出血量少，早期临床疗效满意，理论上可有效降低钢板置人所致的并发症，尤其是减少术后吞咽困难，是前路颈椎钢板内固定的有效替代植入物。加强对颈椎前路围手术期的护理，对有效地减少吞咽困难发生率至关重要。
Objective To comparatively study the clinical efficacy and dysphasia of anterior cervical discectomy with plate fixation and Zero-profile implantation in a prospective study method. Methods 134 cases had been divided randomly into two groups from December, 2009 to February, 2013 according to the inclusion criteria. 71 cases in ACDF group underwent anterior discectomy and interbody fusion with plate internal fixation; 63 cases in group Zero-Profile underwent anterior discectomy and Zero-Profile implantation. All patients had different degrees of neck and shoulder pain, limb pain and numbness and weakness, of which 68 cases complained of feeling of trunk banding and double lower limbs on cotton, and 12 cases complained of mild defecation dysfunction. Single segment operation time, intraoperative bleeding volume, images of pre- operation and postoperation in both groups were compared; VAS, JOA, D value and SWAL-QOL score were assessed. Results All cases were followed up. Follow-up time was 8-24 months with an average （13±2.5） months. The average operation time of each segment in the ACDF and Zero-p groups was （65±11.3） rain and （47±7.6） min, respectively; the average bleeding volume of each segment was （68.5±21.1） ml and （42.7± 14.4） ml, respectively; the average hospital stay was 5.4 days and 4.2 days, respectively. Display： Zero-p group were lower than that in the ACDF group and there was significant difference, no implant subsidence or collapse, screw loosening was found in the two groups;, all patients showed evidence of bony fusion. Conclusions The model of zero notch implant system has the advantages of being simple in operation, short in operation time, mild in bleeding and early in clinical curative effect; this fixation system theorectically can effectively reduce complications caused by the steel structure, especially the common postoperative dysphasia; Hence, it is an effective alternative implant fixation for the anterior cervical plate.
出处
《中国临床解剖学杂志》
CSCD
北大核心
2014年第4期480-483,共4页
Chinese Journal of Clinical Anatomy
