Mobi-C人工颈椎间盘置换术与ROI-C辅助的颈椎前路减压融合术治疗单节段颈椎病的临床研究

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摘要目的比较Mobi-C人工颈椎间盘置换术与ROI-C辅助的颈椎前路减压融合术治疗单节段颈椎病的效果。方法回顾性分析2016年3月至2017年9月在我院治疗的单节段颈椎病患者，对符合标准的35例患者资料进行分组，其中Mobi-C人工颈椎间盘置换术15例，ROI-C辅助的颈椎前路减压融合术20例，术后随访12个月以上。记录手术时间、术中出血量和手术相关并发症。采用日本矫形外科协会(Japanese orthopedic association，JOA)评分、颈部残障功能指数(neck disability index，NDI)及疼痛视觉模拟评分法(visual analogue scale，VAS)评价临床疗效。颈椎侧位X线片测量手术节段局部前凸椎间盘Cobb角和颈椎整体前凸C_2～7Cobb角，过伸过屈位X线片测量颈椎整体活动度(range of motion，ROM)，对术前及随访时的数据进行比较。结果 35例患者均完成随访。两组患者末次随访的JOA评分、NDI评分及VAS评分均较术前有明显改善，两组术前的JOA评分、NDI评分及VAS评分组间比较差异无统计学意义(P＞0.05)，两组末次随访的JOA评分、NDI评分及VAS评分组间比较差异无统计学意义(P＞0.05)。Mobi-C人工颈椎间盘置换术组末次随访椎间盘Cobb角、C_2～7Cobb角、颈椎整体活动度与术前相比差异无统计学意义(P＞0.05)；ROI-C辅助的颈椎前路减压融合术末次随访椎间盘Cobb角及C_2～7 Cobb角与术前相比差异无统计学意义(P＞0.05)，末次随访颈椎整体活动度与术前相比差异有统计学意义(P＜0.05)。两组术前椎间盘Cobb角、C_2～7 Cobb角、颈椎整体活动度的组间比较差异无统计学意义(P＞0.05)；两组末次随访时椎间盘Cobb角、C_2～7 Cobb角、颈椎整体活动度的组间比较差异有统计学意义(P＜0.05)。结论相比于ROI-C辅助的颈椎前路减压融合术，Mobi-C人工颈椎间盘置换术可以取得与前路减压融合内固定术相同的临床效果，而且更好地保持了颈椎活动度，可以作为颈椎病的有效治疗方法。

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关键词 ： Mobi-C, 人工颈椎间盘置换术, ROI-C, 颈椎前路减压融合术

Abstract：Objective To compare the clinical efficacy of Mobi-C artificial disc replacementand anterior cervical discectomyand fusion with ROI-C in treatingsingle-level cervical spondylosis.Methods From March 2016 to September 2017，a total of 35 patients with the cervical spondylosis was treated with Mobi-C artificial disc replacementand anterior cervical discectomyand fusion with ROI-C in our department.they were divided into Mobi-C artificial disc replacement (groupA，15 cases)and anterior cervical discectomyand fusion with ROI-C (groupB，20 cases).The patients were followed up for more than 12 months after operation.Recording operation time，intraoperative blood loss and surgical-related complications.The Japanese Orthopedic Association (JOA)score、cervical disability function index (Neck Disability Index，NDI)and visual analogue scale(VAS)were used to evaluate the clinical efficacy.The lateral X-ray of the cervical spine was used to measure the Cobb angle of the local lordosis and the overall lordosis(C_2～7)of the cervical intervertebral disc.The ROM(range of motion)of the cervical spinewas measured by the dynamic X-ray and the data were compared before and after the follow-up.Results All 35 patients were followed up.JOA、NDI and VAS at the last time were further improved than those at preoperative.There was no significant difference in the preoperative between the two groups in the JOA、NDI and VAS(P＞0.05).There was no significant difference in the final follow-up between the two groups in the JOA、NDI and VAS(P＞0.05).There was no significant difference between preoperative and final follow-up in the Cobb angle of the local lordosis，the overall lordosis(C_2～7)of the cervical intervertebral disc and the range of motion of cervical spine of the Mobi-C artificial disc replacement(P＞0.05)；there was no significant difference between preoperative and final follow-up in the Cobb angle of the local lordosis and the overall lordosis(C_2～7)of the cervical intervertebral disc of anterior cervical discectomyand fusion with ROI-C(P＞0.05).The difference was statistically significant of the range of motion of cervical spine in final follow-up(P＜0.05).There was no significant difference in thepreoperative between the two groups in the Cobb angle of the local lordosis，the overall lordosis(C_2～7)of the cervical intervertebral disc and the range of motion of the cervical spine(P＞0.05).There was significant difference in the final follow-up between the two groups in the Cobb angle of the local lordosis，the overall lordosis(C_2～7)of the cervical intervertebral disc and the range of motion of the cervical spine(P＜0.05).Conclusion Compared with the anterior cervical discectomyand fusion with ROI-C，Mobi-C artificial disc replacement has similar effective treatments in treatingsingle-level cervical spondylosis，and better maintain cervical mobility，which can be used as an effective treatment for cervical spondylosis.

Key words： Mobi-C artificial cervical disc replacement ROI-C anterior cervical decompression and fusion

通讯作者: 王根林

作者简介: 章戈(1993－ )，男，研究生在读，苏州大学附属第一医院骨科，215006。

引用本文:

章戈，张亚中，郑培炎，王根林 *，朱璇琛，彭鹏，姜为民，杨惠林. Mobi-C人工颈椎间盘置换术与ROI-C辅助的颈椎前路减压融合术治疗单节段颈椎病的临床研究[J]. 实用骨科杂志, 2019, 25(6): 481-504.
Zhang Ge，Zhang Yazhong，Zheng Peiyan，et al. Mobi-C ArtificialDisc Replacementand Anterior Cervical Discectomy and Fusion with ROI-C in Treatment of Single-level Cervical Spondylosis. sygkzz, 2019, 25(6): 481-504.

链接本文:

http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2019/V25/I6/481

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