目的:探讨CCRS拉钩在颈椎前路手术中的应用方法及结果。方法:回顾分析2007~2008年在我院完成的97例颈椎前路手术中,应用CCRS拉钩来显露切口者的临床资料,并观察平均手术时间、术中出血量、周围软组织突入手术野的次数、术者术中调整撑开器的次数、患者术后咽部不适时间和医生满意度等指标。结果:该组病例平均手术时间103min,平均术中出血量110 mL,每台次软组织突入术野的次数为0~2次,术者术中调整CCRS 1~2次,患者术后咽部不适1~4 d,医生满意度为95.88%。结论:CCRS拉钩撑开切口后颈前方显露清晰,避免了周围软组织突入颈前操作区,从而提高了手术安全性和术者满意度。
ObjectiveTo investigate the effectiveness of stand-alone MC+polyether-ether-ketone (PEEK) Cage (single blade type) in anterior cervical double-level fusion for more than 2 years follow-up.Methods A clinical data of 30 patients who were treated with anterior cervical fusion surgery with stand-alone MC+PEEK Cage (single blade type) between January 2013 and December 2016 and followed up for more than 2 years, was retrospectively analyzed. There were 16 males and 14 females, aged from 34 to 72 years with an average of 52.2 years. There were 16 cases of cervical spondylotic myelopathy, 8 cases of cervical spondylotic myelopathy, and 6 cases of traumatic cervical disc herniation. The continuous double segments were C4, 5, C5, 6 in 12 cases and C5, 6, C6, 7 in 18 cases; and the disease duration ranged from3 days to 24 months (mean, 12 months). Postoperative neck hematoma and wound healing were observed; dysphagia was assessed by Bazaz system; and bone fusion was assessed by Suk method. Before operation, at 1 week after operation, and at last follow-up, the Japanese Orthopaedic Association (JOA) score was used to evaluate the neurological recovery; the cervical X-ray film was performed to record the cervical curvature (C2-C7 Cobb angle), the height of the intervertebral space of the fusion segment, and to judge the occurrence of the fusion Cage subsidence.ResultsNo complication such as neck hematoma, incision infection, or esophageal fistula was found, primary healing of incisions was obtained in all cases. All patients were followed up 24-72 months (mean, 46 months). Neurological symptoms such as limb numbness and pain gradually disappeared after operation; during the follow-up period, the cervical curvature could be effectively maintained; dysphagia and internal fixation related complications such as displacement of Cages were not found. All patients obtained bony fusion from 3 to 8 months with an average time of 4.3 months. Compared with preoperative ones, the JOA score, intervertebral space height, and Cobb angle of cervical spine were significantly improved at 1 week after operation and at last follow-up (P<0.05), but there was no significant difference between 1 week after operation and last follow-up (P>0.05).ConclusionThe application of stand-alone MC+PEEK Cage (single card type) in anterior cervical fusion can provide early cervical stability, effectively maintain the physiological curvature of cervical spine and the height of fusion intervertebral space.
Objective To explore the anatomical parameters of the cervical uncinate process “inflection point” through cervical CT angiography (CTA) and MRI measurements, offering a reliable and safe anatomical landmark for anterior cervical decompression surgery. Methods A retrospective analysis was conducted on the cervical CTA and MRI imaging data of normal adults who met the selection criteria between January 2020 and January 2024. The CTA dataset included 326 cases, with 200 males and 126 females, aged 22-55 years (mean, 46.7 years). The MRI dataset included 300 cases, with 200 males and 100 females, aged 18-55 years (mean, 43.7 years). Based on the CTA data, three-dimensional models of C3-C7 were constructed, and the following measurements were obtained from the superior view: uncinate process “inflection point” to vertebral artery distance (UIVD), uncinate process tip to vertebral artery distance (UTVD), uncinate process “inflection point” to “inflection point” distance (UID), uncinate process long-axis to sagittal angle (ULSA), and uncinate process “inflection point” to transverse foramen-sagittal angle (UITSA). From the anterior view, the anterior uncinate process to sagittal angle (AUSA) was measured. From the posterior view, the posterior uncinate process to sagittal angle (PUSA) was measured. Based on the MRI data, uncinate process “inflection point” to dural sac distance (UIDD) and dural sac width (DSW) were measured. The trends in measurement parameters of C3-C7 were observed, and the differences in measurement parameters between genders and between the left and right sides of the same segment were compared, as well as the difference in UID and DSW within the same segment was compared. Results The measurement parameters from C3 to C7 in the CTA data showed a general increasing trend, with no significant difference between the left and right sides within the same segment (P>0.05). The UIVD, UTVD, and UID were greater in males than in females, with significant differences observed in the UIVD and UTVD at C3 and C6 and UID at C3, C6, and C7 (P<0.05). The MRI measured DSW showed a general increasing trend from C3 to C7, and the DSW at C6 was greater in females than in males, with a significant difference (P<0.05). The UIDD showed a gradual decreasing trend, with the smallest value at C6. There was no significant difference between males and females or between the left and right sides within the same segment (P>0.05). The UID was greater than the DSW at C3-C7, and the differences were significant (P<0.05). ConclusionThe uncinate process “inflection point” is a constant anatomical structure located at the anteromedial aspect of the uncinate process tip and laterally to the dural sac. It maintains a certain safe distance from the vertebral artery. As a decompression landmark in anterior cervical spine surgery, it not only ensures surgical safety but also guarantees complete decompression.
ObjectiveTo explore the effect on sagittal spine-pelvis balance of different fusion segments in anterior cervical discectomy and fusion (ACDF).MethodsThe clinical data of 326 patients with cervical spondylotic myelopathy, treated by ACDF between January 2010 and December 2016, was retrospectively analysed. There were 175 males and 151 females with an average age of 56 years (range, 34-81 years). Fusion segments included single segment in 69 cases, double segments in 85 cases, three segments in 90 cases, and four segments in 82 cases. Full spine anterolateral X-ray films were performed before operationand at 12 months after operation. The spine-pelvis parameters of fusion segments were measured and compared. The parameters included C0-2 Cobb angle, C2-7 Cobb angle, C2-7 sagittal vertical axis (C2-7 SVA), T1 slope (T1S), thoracic inlet angle (TIA), thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), sacral slope (SS), C7 sagittal vertical axis (C7 SVA), T1 pelvic angle (TPA). The Japanese Orthopaedic Association (JOA) score of cervical spine and visual analogue scale (VAS) scores of pain of cervical spine and upper extremity were compared before operation and at 12 months after operation. Pearson correlation analysis was performed on LL, PI, SS, C7 SVA, and TPA before and after operation to evaluate the changes of spine-pelvis fitting relationship after ACDF.ResultsAll 326 patients were followed up 12-32 months (mean, 18.5 months). During the follow-up period, internal fixator was in place, and no spinal cord nerve or peripheral soft tissue injury was found. JOA scores and cervical VAS scores improved significantly at 12 months after operation (P<0.05), no significant difference was found in VAS scores of upper extremity when compared with preoperative scores (P>0.05). The preoperative cervical VAS scores and the postoperative JOA scores at 12 months had significant differences between groups (P<0.05). At 12 months after operation, there was no significant difference in sagittal spine-pelvis parameters in the single segment group compared with preoperative ones (P>0.05); but the C0-2 Cobb angle, C2-7 Cobb angle, C2-7 SVA, T1S, TIA, C7 SVA, and TPA in the double segments, three segments, and four segments groups were significant larger than preoperative ones (P<0.05). The C0-2 Cobb angle, C2-7 Cobb angle, T1S, C7 SVA, and TPA among 4 groups had significant differences before operation and at 12 months after operation (P<0.05). At 12 months after operation, the changes of C7 SVA and TPA in the double segments, three segments, and four segments groups were significantly larger than those in the single segment group (P<0.05). PI had positive correlations with LL and SS before and after operation in 4 groups (P<0.05).ConclusionNormal fitting relationship between lumbar spine and pelvis in physiological state also exists in patients with cervical spondylotic myelopathy, and ACDF can not change this specific relationship. In patients with cervical spondylotic myelopathy, the sagittal spine-pelvis sequence do not change after ACDF single-level fusion, while the sagittal spine-pelvis balance change after double-level and multi-level fusion.
Objective To study the clinical application ofheterogenous bone graft combined with auto-marrow. Methods Deproteinated and degreased heterogenouscancellous bone combined with auto-marrow was used in 21 cases of anterior cervical interbody fusion. Among them, 2 cases were treated by bone graft only, and the other 19 cases were further treated by anterior plate fixation. Results The follow-up time was 12-36 months with an average of 21 months. After operation, posteroanterior and lateral radiograph of all the cases revealed that the reduction and the position of the grafting bone were good without inflammation or other complications. After 6 months of operation, the radiograph of 2 cases of cervical disk herniation, which were treated by bone graft only, showed the bones lost their height and the curve of the cervical spine returned to the state of preoperation. For the other cases, the grafting bonesremained their original figure without dislocation of the bone or fracture of the plate or the screw. The nervous function recovered variously. Before operation, 10 cases were ranked as grade A,7 cases grade C, 4 cases grade D according to Frankel classification. After operation, in grade A cases, 5 cases did not recover, 3 cases recovered to grade B, 2 cases to grade C; in grade C cases, 5 to grade D, 2 to grade E; all ofgrade D 4 cases to grade E. Conclusion Heterogenous bone combined with auto-marrow can be used as grafting material in the anterior cervical interbodyfusion, but its mechanical rigidity need to be improved or the fusion shouldbe aided with rigid internal fixation.
目的:探讨早期护理干预对颈椎前路手术患者康复的影响。方法:选择颈椎前路手术患者66 例。分为实验组33例和对照组33例,实验组实施系统的早期护理干预活动指导,对照组进行常规护理,比较两组术后卧床时间、住院天数、术后并发症及术后生活质量。结果:实验组卧床时间及住院天数、术后并发症发生率均低于对照组 (Plt;0.05), 生活质量优于对照组 (Plt;0.05)。结论:早期护理干预有利于颈椎前路手术患者术后恢复
ObjectiveTo compare the effect on adjacent segment degeneration after cervical disc arthroplasty (CDA) and anterior cervical decompression and fusion (ACDF) for treatment of cervical spondylosis. MethodsBetween August 2009 and February 2012, 60 cases of single segmental cervical spondylosis accorded with the inclusion criteria were included. Of 60 patients, 28 patients underwent CDA (CDA group) and 32 patients underwent ACDF (ACDF group). There was no significant difference in gender, age, disease duration, pathological type, pathological segment, the time of conservation treatment, preoperative neck disability index (NDI), preoperative Japanese Orthopaedic Association (JOA) score, and degeneration of the adjacent segment and disc between 2 groups (P > 0.05). The NDI and JOA score were used to evaluate effectiveness. The range of motion (ROM) of adjacent segment was measured, and degeneration of the adjacent segment and disc was evaluated according to Kellgren grading system based on X-ray and Miyazaki grading system based on T2-weighted MRI, respectively. ResultsThe follow-up time was 24-50 months (mean, 34 months) in 2 groups. All patients had no complication of prosthesis loosening, dislocation, or fracture of plate. The NDI and JOA scores from 12 months after operation were significantly improved compared with preoperative scores in 2 groups (P < 0.05), but no significant difference was found at each time point between 2 groups (P > 0.05). The improvement rate of JOA was 80.68%±4.01% in ACDF group and was 79.44%±3.76% in CDA group at last follow-up, showing no significant difference (t=1.237, P=0.221). And the improvement rate of JOA in 2 groups were excellent. There was no significant difference in ROM and degeneration grading of adjacent segments between at last follow-up and at pre-operation in 2 groups (P > 0.05), and between 2 groups at pre-operation and at last follow-up (P > 0.05). The degeneration grading of disc at last follow-up showed significant difference in 2 groups compared with preoperative ones (P < 0.05), but no significant difference was found between 2 groups (Z=0.132, P=0.895). ConclusionBoth CDA and ACDF can achieve good effectiveness in treating cervical spondylosis, but CDA can not significantly slow down the degeneration of adjacent segment disc.
【摘要】 目的 探讨纳米羟基磷灰石/聚酰胺66（nano-hydroxyapatite polyamide66，n-HA/PA66）颈椎融合器在颈椎间盘突出症前路手术重建中的临床疗效。 方法 2008年12月-2010年6月，对14例颈椎间盘突出症患者行前路椎间盘切除、椎管减压，以n-HA/PA66椎间融合器支撑植骨、钢板螺钉内固定治疗。随访时间3～12个月，平均6.3个月；随访时以日本矫形外科学会（Japan Orthopaedic Assoctiation， JOA）评分改善率评价患者神经功能恢复情况，复查X线片评估椎间融合器植骨融合情况，包括椎间高度及椎间融合器下沉情况。 结果 14例患者均成功完成颈椎前路减压手术以及椎间融合器的安放固定。所有患者术前症状均得到不同程度的改善，术后3、6、12个月的JOA改善率分别为87.0%、94.0%、97.0%。影像学检查显示所有患者植骨融合，椎间高度及椎间融合器的位置维持良好，无下沉、移位。 结论 n-HA/PA66颈椎间融合器具有早期支撑稳定功能，可有效维持颈椎椎间高度；术后植骨融合率高且便于X线片观察，是颈椎间盘突出症患者前路手术植骨的理想支撑材料，但长期效果需进一步随访观察。【Abstract】 Objective To evaluate the clinical effect of artificial cervical vertebra fusion apparatus of n-HA/PA66 in anterior reconstruction of cervical intervertebral disc herniation. Methods From December 2008 to June 2010, 14 patients with cervical intervertebral disc herniation underwent anterior cervical discectomy,spinal canal decompression,spinal canal decompression and reconstruction by n-HA/PA66 composite artificial vertebral body combined with plate instrumentation. The patients were followed up for 3 to 12 months with an average of 6.3 months. Neurological function was evaluated by improvement rate of JOA score and situations of the supporting body was observed by X-ray in 3,6,and 12 months after the surgery.The intervertebral height,the 1ocations, and the fusion rate of the supporting body were assessed in order to evaluate the stability of the cervical spine and alignment improvements. Results All the patients had undergone the operation successfully.The preoperative symptoms improved to varying degrees.JOA improvement rate were 87.0%, 94.0%, and 97.0% 3,6,and 12 months after the operation,respectively.Imaging studies showed that in all cases graft fusion were achieved,and cervical alignments,intervertebral height,cervical spine stability and the locations of the artificial vertebral body were well maintained.No displacement and subsidence of the artificial vertebral body occurred. Conclusion n-HA/PA66 artificial vertebral body can provide early cervical spine support and stability and cervical intervertebral height.It has a high rate of graft fusion and is convenient to observe by X-ray.Therefore,n-HA/PA66 can be taken as an ideal graft for anterior degenerative cervical spine operation,but further follow-up study is still needed to evaluate the long-term effects.