创伤性椎间盘突出脊髓损伤两种颈椎前路融合

Two types of instrumented anterior cervical decompression and fusion for traumatic disc herniation accompanied with spi⁃ nal cord injury

摘要:

［目的］比较零切迹锁定型颈椎融合器（zero-profile, stand-alone cervical cage, ROI-C）与传统颈椎前路椎间融合器联合钛板 （cage and plate, CP） 治疗创伤性椎间盘突出伴脊髓损伤的临床效果。［方法］ 回顾性分析 2015 年 9 月—2020 年 9 月收治的 44 例接受颈椎前路手术治疗的创伤性椎间盘突出伴脊髓损伤患者。依据医患沟通结果，21 例采用 ROI-C，23 例采用 CP。比较两组围手术期、随访及影像结果。［结果］ 两组患者手术均顺利，无严重术中并发症。ROI-C 组手术时间、切口长度、术中透视次数、术中失血量、下地行走时间及住院时间均显著优于 CP 组 （P<0.05）。两组患者随访时间平均 （16.8±3.2） 个月，ROI-C 组恢复完全负重活动时间显著早于 CP 组（P<0.05）。随时间推移，两组 ASIA 评级、JOA 评分、NDI 评分及锥体术征情况均显著改善（P<0.05）。术前两组患者上述指标的差异均无统计学意义（P>0.05），术后 1、3 个月，ROI-C 组 ASIA 评级显著优于 CP 组（P<0.05）。影像方面，术后两组患者 C_2~7 Cobb 角和椎间隙高度均较术前显著改善（P<0.05），术前两组上述影像指标的差异均无统计学意义 （P>0.05），术后相应时间点 ROI-C 组椎间隙高度显著优于 CP 组 （P<0.05）。术后 3 个月， ROI-C 组椎体间融合情况优于 CP 组（P<0.05）。［结论］对于创伤性椎间盘突出伴脊髓损伤，两种术式均能改善神经功能，改善颈椎生理曲度和维持椎间隙高度。与传统 CP 相比，ROI-C 组具有创伤小、手术时间短等优点，而且恢复患者颈椎椎间隙高度效果明显。

Abstract:

[Objective] To compare the clinical outcomes of zero-profile stand-alone cervical cage (ROI-C) versus conventional cage and plate (CP) used in anterior cervical decompression and fusion (ACDF) for traumatic disc herniation accompanied with spinal cord inju- ry. [Methods] A retrospective study was performed on 44 patients who received ACDF for traumatic disc herniation with spinal cord injury in our department from September 2015 to September 2020. According to doctor-patient communication, 21 patients received ACDF with ROI-C, while the remaining 23 patients had conventional CP used. The perioperative, follow-up and imaging data were compared between the two groups. [Results] All patients in both groups had operation performed successfully without serious intraoperative complications. The ROI-C group proved significantly superior to the CP group in terms of operation time, incision length, intraoperative fluoroscopy times, in- traoperative blood loss, postoperative walking time and hospital stay (P＜0.05). All of them were followed up for (16.8±3.2) months on an av- erage, and the ROI-C group resumed full weight-bearing activities significantly earlier than the CP group (P＜0.05). The ASIA grade for neurological function, JOA and NDI scores and pyramidal signs improved significantly over time in both groups (P＜0.05). Although there were no statistically significant differences in the abovesaid items between the two groups before surgery (P＞0.05), the ROI-C group proved significantly superior to the CP group in term of ASIA grade 1 and 3 months after operation (P＜0.05). Regarding imaging, postoperative C_2~7 Cobb angle and intervertebral height significantly improved in both groups compared with those before surgery (P＜0.05), which was not sta- tistically significant between the two groups before surgery (P＞0.05), the ROI-C group got significantly higher intervertebral space height than the CP group at all time points postoperatively (P＜0.05). In addition, the ROI-C group had significantly better intervertebral fusion than the CP group three months after surgery (P＜0.05). [Conclusion] Both procedures do improve neurological function, improve cervical physiological curvature, and maintain intervertebral height for traumatic disc herniation with spinal cord injury. Compared with traditional CP, the ROI-C has the advantages of less trauma and shorter operation time, and more obvious effect of restoring the height of cervical inter- vertebral space.