ROI-C前路手术治疗无椎节不稳 、骨折或脱位TCDH临床疗效观察

摘要

目的 探讨无椎节不稳、骨折或脱位的创伤性颈椎间盘突出(traumatic cervical disc herni-ation,TCDH)患者单独采取双插片自稳式融合系统(double-plate self-locking interbody fusion device,商品名ROI-C)前路手术治疗的初期效果并对该手术方法进行评价.方法 回顾性分析2008年1月至2016年1月于我院治疗的TCDH患者120例,观察比较应用ROI-C前路手术治疗前后日本骨科协会评分(Japanese Orthopaedic Association scores,JOA)、 视觉疼痛模拟评分(visual analogue scale,VAS)、 颈椎功能障碍指数(neck disability index,NDI)、 颈椎整体曲度的改变及椎间高度,依据Vaccraro标准对植骨融合情况进行评估,应用Odom法对手术治疗效果进行评定.结果 120例患者均获得随访,随访时间13~34个月,平均19.5个月.手术前至末次随访评分的比较,治疗后JOA评分由4.4±3.9增加为13.9±2.7;VAS评分由6.4±2.1下降为1.1±0.8;NDI评分由38.3%±11.8%减少为8.8%±3.3%,末次随访前与术前的差异均具有统计学意义(P<0.05).治疗后椎间高度由(5.3±1.6)mm增加为(7.9±0.7)mm,颈椎曲度由5.2°±7.4°增加为10.6°±5.2°,差异具有统计学意义(P<0.05).术后2周声音嘶哑患者症状消失,术后3个月吞咽困难患者症状消失,术后6个月120例节段均发生骨性融合,随访期间无ROI-C下沉、移位及断裂现象的发生.依据Odom标准评优率为76.5%.结论 单独采取ROI-C前路手术方式治疗无椎节不稳、骨折或脱位的TCDH患者,确实具有治疗效果较好、融合率高及并发症少等优势,ROI-C前路固定融合治疗是一种可靠的微创手术方法,值得临床推广.%Objective To investigate the effect of double-plate self-locking interbody fusion device (ROI-C) on the treatment of traumatic cervical disc herniation (TCDH) without vertebral instability, fracture or dislocation,and to evaluate the effect of surgery. Methods A total of 120 patients with TCDH who were treated in our hospital from January 2008 to January 2016 were retrospectively analyzed.The pre-and post-operative Japanese Orthopedic Association score (JOA) and visual analogue score (VAS) were observed and compared.The neck disability index ( NDI), total cervical curvature changes and intervertebral heights, Vaccraro criteria for bone graft fusion assessment, and Odom criteria were used to evaluate the surgical effects . Results All patients were followed up for 13 to 34 months with an average of 19.5 months.The JOA score increased from 4.4 ±3.9 to 13.9 ±2.7 by the end of the follow-up.The VAS decreased from 6.4 ±2.1 to 1.1 ±0.8 (P <0.05); The NDI decreased from 38.3% ±11.8% to 8.8% ±3.3%(P <0.05).The inter-vertebral height increased from (5.3 ±1.6) mm to (7.9 ±0.7) mm(P <0.05); The curvature of the cervical spine increased from 5.2°±7.4 °to 10.6°±5.2 °(P <0.05).The symptoms of hoarseness disappeared 2 months later.The symptoms of dysphagia disappeared 3 months later.All the segments got bony fusion 6 months later.There was no ROI-C sinking, displacement or fracture phenomenon occurred .According to the Odom criteria, the excellent rate was 76.7%(92 /120). Conclusions The treatment of TCDH without verte-bral instability, fracture or dislocation by the ROI-C anterior approach alone does have the advantages of good therapeutic effect, high fusion rate and less complication .ROI-C anterior fusion therapy is a reliable minimally invasive surgical method, which is worthy of clinical promotion .