双插片自稳融合器选择性治疗创伤性颈椎间盘突出症初步报告

目的 :讨论单独应用双插片自稳式融合系统(double plate self locking interbody fusion device,ROI-C)前路手术治疗无椎节不稳、骨折或脱位的创伤性颈椎间盘突出症(traumatic cervical disc herniation,TCDH)的初期临床疗效。方法:自2011年12月至2013年12月采用前路切除受损椎间盘和突出物减压、ROI-C植骨融合固定选择性治疗17例TCDH,其中男12例,女5例;年龄24~41岁,平均32.9岁;单节段11例,双节段4例,三节段2例。观察比较手术前后日本骨科协会评分(Japanese Orthopaedic Association,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),椎间高度和颈椎整体曲度变化,并依据Vaccraro标准判断植骨融合情况。采用Odom法进行疗效评定。结果:所有病例获得随访,时间12~33个月,平均18.5个月。JOA评分由术前的4.3±3.8增加至末次随访时的13.9±2.5;VAS评分由术前的6.5±2.2减少至末次随访时的1.0±0.9;NDI由术前的(38.2±11.7)%减少至末次随访时的(8.7±3.4)%;末次随访与术前比较差异均有统计学意义(P0.05)。椎间高度和颈椎曲度分别由术前的(5.2±1.7)mm、(5.1±7.5)°增至末次随访时的(7.8±0.6)mm和(10.5±5.1)°,差异有统计学意义(P0.05)。术后出现声音嘶哑1例,吞咽困难2例,分别术后2周和术后3个月症状消失。术后6个月所有节段均获骨性融合,随访期间未发现ROI-C移位、下沉或断裂。按照Odom标准评判疗效,优13例,良3例,可1例。结论:单独使用ROI-C前路固定融合治疗无椎节不稳、骨折或脱位的TCDH是有效、微创和可靠的手术方法,具有并发症少、融合率高、疗效好的优点。

The preliminary clinical study about the effectiveness of selective treatment for traumatic cervical disc herniation with stand-alone RIO-C

Objective:To discuss the efficacy of a new double-plate self-locking interbody fusion device(ROI-C) in the anterior cervical discectomy and fusion(ACDF) to treat traumatic cervical disc herniation(TCDH) without segmental instability,fracture or dislocation.Methods:ACDF with stand-alone ROI-C was performed in 17 selective TCDH patients between December 2011 and December 2013. There were 12 males and 5 females,aged from 24 to 41 years old with a mean of 32.9 years,including 11 patients with single segment,4 patients with double segments and 2 patients with three segments. Japanese Orthopaedics Assiciation (JOA),visual analogue scale(VAS) score and the Neck Disability Index(NDI) were recorded before and after operation in order to evaluate the clinical outcome,meanwhile,the preoperative and postoperative X-ray films were collected to measure the intervertebral space height and whole cervical curvature. According to Vaccraro criteria to observe the bone fusion. The clinical effects were assessed according to Odom criteria.Results:All patients were followed up from 12 to 33 months with an average of 18.5 months. JOA score was increased significantly from preoperative 4.3±3.8 to 13.9±2.5 at final follow-up (P<0.05). VAS,NDI were decreased from preoperative (6.5±2.2) scores and (38.2±11.7) % to (1.0±0.9) scores and (8.7±3.4) % in final follow-up,respectively (P<0.05). Intervertebral space height and cervical curvature were increased from preoperative (5.2±1.7) mm and (5.1±7.5) ° to (7.8±0.6) mm and (10.5±5.1) °,respectively(P<0.05). Hoarseness occurred in one patient and dysphagia occurred in 2 patients and they recovered spontaneously in 2 weeks and 3 months after operation,respectively. All the segments (25 levels) of the 17 cases achieved bony fusion in 6 months after operation. No displacement,subsidence and failure of ROI-C were found during follow-up. According to Odom''s criteria to evaluate clinical effects at the last follow-up,13 cases got excellent results,3 good,and 1 fair.Conclusion:ACDF with stand-alone ROI-C is an effective,minimally invasive and reliable method in treating TCDH without segmental instability,fracture or dislocation,it can obtain satisfactory clinical outcomes and has advantage of less complications,high fusion rate.