Department of Orthopaedic Surgery, Qilu Hospital of Shandong University, Jinan, China.
Cheeloo College of Medicine, Shandong University, Jinan, China.
Orthop Surg. 2023 Feb;15(2):510-516. doi: 10.1111/os.13618. Epub 2022 Dec 13.
Although Caspar cervical retractor system (CCRS) is commonly utilized in anterior cervical decompression and fixation (ACDF), most urban hospitals still use both traditional S retractor and CCRS in conventional anterior cervical surgeries. Related data to evaluate the effect are required to be reported. The aim of this study is to compare the efficacy between using the traditional cervical S retractor and CCRS in anterior cervical decompression and fixation ACDF.
The retrospective study that total 360 patients received ACDF using different retractors (traditional S retractor or CCRS) were enrolled in this study from January 2010 to January 2020. Width change rate of cervical prevertebral soft tissue, throat symptoms, and subjective experiences of the operating surgeons were evaluated by t-test or analysis of variance (ANOVA) respectively.
The width change rate of prevertebral soft tissue was significantly higher in the S retractor group than that of the CCRS group both in single segment group (40.9% vs 20.8%, P < 0.05) and double segments group (45.8% vs 25.2%; p < 0.05). In the three segments group, the width change rate of prevertebral soft tissue was higher in the S retractor group than that of the CCRS group, but with no statistical significance (27.3% vs 23.6%; P > 0.05). The incidence rates of dysphagia, dyspnea, and throat discomfort in the traditional S retractor group were significantly higher compared to the CCRS group (P < 0.05), while satisfactory rate of surgeon was higher in the CCRS group (P < 0.05). However, there was no correlation between anterior soft tissue rate and operative time (P > 0.05), as well as the width change rate of anterior soft tissue and the DNRS score (P > 0.05).
CCRS was superior compared to the traditional S retractor in reducing the postoperative complications and the postoperative fatigue of surgeon. Meanwhile, the width change rate of prevertebral soft tissue was not related to operative time and DNRS score.
尽管 Caspar 颈椎牵开器系统（CCRS）常用于前路颈椎减压和固定（ACDF），但大多数城市医院在常规前路颈椎手术中仍同时使用传统的 S 牵开器和 CCRS。需要报告相关数据来评估其效果。本研究旨在比较传统颈椎 S 牵开器和 CCRS 在前路颈椎减压和固定 ACDF 中的疗效。
回顾性研究，共纳入 2010 年 1 月至 2020 年 1 月间使用不同牵开器（传统 S 牵开器或 CCRS）接受 ACDF 的 360 例患者。采用 t 检验或方差分析（ANOVA）分别评估颈椎椎体前软组织的宽度变化率、咽喉症状和手术医生的主观体验。
单节段组（40.9%比 20.8%，P<0.05）和双节段组（45.8%比 25.2%，P<0.05）中，S 牵开器组的椎体前软组织宽度变化率明显高于 CCRS 组。在三节段组中，S 牵开器组的椎体前软组织宽度变化率高于 CCRS 组，但无统计学意义（27.3%比 23.6%，P>0.05）。传统 S 牵开器组吞咽困难、呼吸困难和咽喉不适的发生率明显高于 CCRS 组（P<0.05），而 CCRS 组的手术医生满意度较高（P<0.05）。然而，前软组织率与手术时间之间无相关性（P>0.05），前软组织宽度变化率与 DNRS 评分之间也无相关性（P>0.05）。
与传统 S 牵开器相比，CCRS 可减少术后并发症和手术医生的术后疲劳。同时，椎体前软组织的宽度变化率与手术时间和 DNRS 评分无关。
