颈前路零切迹减压融合术对邻近节段瞬时旋转中心及活动度的影响研究

摘要

目的：探讨颈前路零切迹减压融合术对邻近节段瞬时旋转中心（instantaneous center of ro⁃tation, ICR）及活动度（range of motion, ROM）的影响。方法对2011年10月至2014年12月的122例采用颈前路零切迹自锁式椎间融合器行颈前路减压融合术（anterior cervical decompression and fusion, ACDF）的患者进行回顾性分析。收集患者术前及末次随访时的过伸、过屈位X线片，测量邻近节段的ICR、ROM以及颈椎整体ROM。采用疼痛视觉模拟量表（visual analogue scale, VAS）评分、日本骨科协会（Japanese Orthopaedic Association, JOA）评估治疗分数、颈椎功能障碍指数（neck disability index, NDI)评价治疗效果。结果随访3~21个月，平均6个月。无论是融合上方还是下方相邻节段的ICR，其术前与末次随访时的数值差异均无统计学意义（均P＞0.05）；对于颈椎整体和屈、伸位ROM，其术前与末次随访时的数值差异均有统计学意义（均P＜0.05），但其上下方相邻节段手术前后的ROM比较，差异均无统计学意义（均P＞0.05）；本组手术前后的VAS评分、JOA评分及NDI的比较，差异均有统计学意义（均P＜0.05）。结论采用颈前路零切迹减压融合术治疗颈椎病效果良好，对邻近节段的ICR和ROM未造成明显的影响。%Objective To evaluate the instantaneous center of rotation (ICR) and range of motion (ROM) of the cervical adjacent segment after anterior cervical discectomy and self⁃locking cage fusion. Meth⁃ods A retrospective analysis was conducted on 122 patients who underwent anterior cervical discectomy and self⁃locking cage fusion between October 2011 and December 2014. The flexion and extension cervical X⁃rays were obtained before surgery and the final post⁃surgery check up and the ICR, ROM of the cervical adjacent seg⁃ment were measured. The visual analogue scale (VAS), Japanese Orthopaedic Association (JOA) Scores and neck disability index (NDI) were used to evaluate the clinical effectiveness. Results The patients were fol⁃lowed up for 6 months (range, 3⁃21 months). There were no significant differences in the cervical adjacent seg⁃ment before surgery and the final post⁃surgery check up (all P>0.05). The changes of the flexion, extension and the whole cervical before surgery and the final post⁃surgery check up showed statistically significant difference (all P<0.05), but there was no significant difference in the ROM of adjacent segment (all P>0.05). There was sta⁃tistically significant difference in VAS scores, JOA and NDI (all P<0.05). Conclusion The effectiveness of an⁃terior cervical discectomy and self⁃locking cage fusion is satisfactory, and the influence of ICR and ROM on the adjacent segment is not obvious.