颈椎前路椎间盘切除融合术中颈椎曲度调节△

Intraoperative cervical curvature adjustment by a self-developed instrument in anterior cervical discectomy and fusion

摘要:

[目的] 探讨术中颈椎曲度调节对颈椎前路椎间盘切除减压融合术 (anterior cervical discectomy and fusion, ACDF) 术后颈椎曲度及临床疗效的影响。[方法] 2020 年 1 月—2021 年 3 月，对 36 例行 ACDF 手术的患者术中采用自主研制的可调式电动颈椎前路手术体位固定装置进行颈椎曲度调节，观察术后临床与影像指标。[结果] 所有患者均顺利完成手术，无严重并发症。患者术后临床症状显著改善。随时间推移，患者日本骨科协会评分 (Japanese Orthopaedic Association Score, JOA) 显著增加 (P＜0.05)，而颈部功能障碍指数 (neck disability index, NDI) 和疼痛视觉模拟评分 (visual analogue scale, VAS) 均显著下降(P＜0.05)。影像方面，相较于术前及麻醉后曲度调节前，在曲度调节后、内置物放置后及出院前 3 d，患者整体前凸曲度及手术节段前凸曲度显著增加 (P＜0.05)。此后，整体及手术节段前凸曲度有所下丢失，但差异均无统计学意义 (P＞0.05)。 [结论] 在 ACDF 手术中，通过术中调节颈椎曲度，能维持乃至改善颈椎术后整体及节段曲度。

Abstract:

[Objective] To investigate the effect of intraoperative cervical curvature adjustment by a self-developed instrument in anteri- or cervical discectomy and fusion (ACDF) on the clinical and radiographic consequences. [Methods] From January 2020 to March 2021, 36 patients underwent ACDF with intraoperative cervical lordotic curvature adjustment by the self-developed instrument. The postoperative out- comes, involving clinical and imaging parameters, were observed and compared. [Results] All patients were successfully operated on with- out serious complications, and got significant improvement in clinical symptoms gradually postoperatively. The JOA scores increased signifi- cantly (P＜0.05) , whereas the NDI and VAS scores decreased significantly over time (P＜0.05) . Radiographically, overall lordotic curvature (C2~C7 Cobb angle) and segment lordotic curvature (local Cobb angle) were significantly increased after the intraoperative curvature adjust- ment, implant placement, and 3 days before discharge compared with those before operation and after anesthesia (P＜0.05) . After that, over- all lordotic curvature and segment lordotic curvature tended to be lost again in some extent during the following time points in the follow-up period, but which were not statistically significant (P＞0.05) . [Conclusion] This intraoperative adjustment of cervical curvature during ACDF by the self-developed instrument does maintain, even improve the postoperative overall and segmental curvature of cervical spine.