一种新型植骨重建钛网的初步临床应用

Primary clinical using of a new titanium mesh cage for bone grafting

目的评价新型植骨重建钛网在颈前路椎体次全切除减压植骨融合术中的临床应用及疗效。方法采用颈前路椎体次全切除减压、新型钛网植骨融合术治疗颈椎退行性疾病患者53例,其中男38例,女15例,年龄39～76岁,平均49.7岁。手术方式包括单节段椎体次全切除22例,单节段椎体次全切除联合椎间盘切除减压28例,双节段椎体次全切除3例。术后定期随访颈椎X线片,比较术后椎间高度及颈椎生理曲度变化。采用日本骨科学会的JOA评分系统进行神经功能评价。结果单节段手术患者椎间高度从术前22.3mm±0.8mm增加至术后24.5mm±0.6mm,双节段手术患者椎间高度从术前平均42.3mm增加至术后平均45.7mm,6个月随访两者均无明显丢失。单节段手术患者颈椎曲度从术前8.2°±1.4°增加至术后14.5°±1.6°,但双节段手术患者颈椎曲度术前平均6.3°,术后平均仅为7.0°,6个月随访两者均无明显丢失。全部患者临床神经功能均有改善,JOA评分从术前8.4±0.5分提高至术后12.2±0.4分,6个月随访提高至14.5±0.3分。结论新型钛网的外形设计更符合颈椎椎体终板形态学特点,可有效避免术后钛网沉陷,临床应用单节段手术能够较好的重建颈椎椎间高度和生理曲度,而双节段手术由于该新型钛网设计的不足之处对于颈椎生理曲度的重建作用有限,有待进一步改进。

Objective To evaluate the clinical effect of a new type titanium mesh cage（TMC）in the procedure of anterior cervical corpectomy and fusion（ACCF）.Methods A total of 53 patients（38 males and 15 females,mean age at 49.7 years old,ranging from 39 to 76 years）with cervical degenerative diseases were treated by ACCF with the new type TMC.The surgical procedures included one-level corpectomy in 22 patients,one-level corpectomy with discectomy in 28 patients and two-level corpectomies in 3 patients.Roentgenographs were taken postoperatively to observe intervertebral height and cervical alignment.The neurological function was evaluated by JOA scoring system.Results The mean intervertebral height increased from 22.3mm±0.8mm to 24.5mm±0.6mm after operation in one-level corpectomy patients,while from 42.3 mm to 45.7 mm after operation in two-level operation patients.The mean cervical lordosis increased from 8.2°±1.4° to 14.5°±1.6° after operation in one-level corpectomy patients,while from 6.3° to 7.0° after operation in two-level operation patients.The mean intervertebral height and cervical lordosis did not have any lose in six-month follow-up.The mean JOA score increased from 8.4±0.5 points to 12.2±0.4 points after operation,and significantly increased to 14.5±0.3 points at six-months follow-up.Conclusion The new type TMC can be helpful to avoid postoperative subsidence due to its unique design according to the vertebral endplate morphology.The new type TMC has be proved to be favor of restoring the intervertebral height and cervical alignment for one-level corpectomy patients,while having limitation in restoring the cervical alignment for two-level corpectomy patients because of defects in its design.