桥形固定颈椎前路融合器ROI-C在颈椎内固定治疗中的初步疗效分析

摘要

BACKGROUND:With the extensive application of anterior titanium plate, postoperative complications such as dysphagia, titanium loose, screw exit and disc degeneration of neighboring segments induced more and more attention of researchers. However, the application of anterior cervical cage is expected to avoid these complications. OBJECTIVE:To observe primary curative effect of anterior cervical cage ROI-C in anterior cervical spine surgery. METHODS:A total of 32 patients with cervical spondylosis were treated with anterior cervical cage ROI-C in the Wuxi Ninth Hospital Affiliated to Soochow University from April to December 2013. The cage was implanted to promote interbody fusion. Of 32 cases, 23 cases affected cervical spondylotic myelopathy, 2 cases affected nerve root type cervical spondylosis, 3 cases affected cervical hyperextension injury, 1 case affected cervical disc herniation, 2 cases affected cervical instability and 1 case affected segmental cervical ossification of the posterior longitudinal ligament. Japanese Orthopaedic Association and NDI scores were determined to assess neurological symptoms and functional improvement before internal fixation and during final fol ow-up. Simultaneously, adverse reactions were recorded. RESULTS AND CONCLUSION:A total of 32 patients finished the regular fol ow-up for 4 to 8 months. Clinical symptoms and spinal cord function of al patients were obviously improved. No ROI-C loosing or displacement or secondary surgery was found. The average fusion time was 4.2 months (3 to 5 months). Mean score of Japanese Orthopaedic Association was increased from 9.2 points pre-surgery to 13.8 points post-surgery. Japanese Orthopaedic Association and NDI scores were higher during final fol ow-up than before fixation (P<0.05). These data indicated that ROI-C effectively restored intervertebral height in anterior cervical spine surgery, stably reconstructed cervical vertebra, obtained interbody fusion, effectively avoided related surgical complications induced by plate implantation, improved neurological symptoms and function, and showed good short-term effects.%背景：随着前路钛板的广泛应用，术后一些并发症如吞咽困难、钛板松动、螺钉退出及邻近阶段椎间盘退变等越来越引起研究者的关注，而桥形固定颈椎前路融合器系统的应用有望避免这些并发症。　　目的：观察桥形固定颈椎前路融合器ROI-C在颈椎前路手术中应用的初步疗效。　　方法：2013年4至12月，苏州大学附属无锡九院应用ROI-C进行前路减压融合内固定治疗颈椎病患者32例，融合器中均植入骨诱导促进椎间融合。32例中脊髓型颈椎病23例，神经根型颈椎病2例，颈髓过伸伤3例，颈椎间盘突出1例，颈椎不稳2例，节段性颈椎后纵韧带骨化1例。内固定前及末次随访时测定JOA及NDI评分评价神经症状及功能改善情况，同时记录不良反应。　　结果与结论：32例患者均完成了4-8个月的门诊定期随访，所有患者的临床症状、脊髓功能明显改善，未出现ROI-C松动移位及二次手术。椎间融合平均时间4.2个月(3-5个月)；JOA评分由内固定前平均9.2分上升至术后13.8分，末次随访时JOA评分、NDI评分均较内固定前提高(P<0.05)。提示ROI-C在颈椎前路手术中能有效地恢复病变椎间隙高度，能获得颈椎稳定性重建及椎体间融合，有效避免因植入钢板固定而引起的相关手术并发症，改善神经症状及功能，近期效果良好。