颈前路椎体切除植骨融合术后钛网沉陷的临床研究

Clinical study on subsidence of titanium mesh cage after anterior cervical corpectomy and fusion

目的探讨颈前路椎体切除植骨融合术后钛网沉陷的风险因素以及钛网沉陷对临床疗效的影响。方法 2003年5月～2007年8月采用颈前路椎体切除植骨融合术治疗颈椎疾病患者300例。分析患者的年龄、性别、切除节段、固定钢板的类型以及是否使用垫片这5个因素是否为钛网沉陷的风险因素,研究钛网沉陷对颈椎曲度及其他临床疗效的影响。结果随访1年,239例(79.7%)患者发生钛网沉陷,其中182例(60.7%)发生轻度沉陷(1～3mm),57例(19.0%)发生严重沉陷(>3mm)。双节段切除较单节段切除更易发生严重钛网沉陷。发生严重钛网沉陷的患者术后神经功能恢复率明显低于未发生钛网沉陷的患者。同时,钛网严重沉陷增加了患者颈肩部疼痛、神经症状复发以及内固定失败的发生率。结论钛网沉陷在颈前路椎体切除钛网植骨融合术后发生较为普遍。多节段切除是发生严重钛网沉陷的危险因素,严重钛网沉陷可导致手术疗效下降及相关并发症的发生。

Objective To clarify risk factors for subsidence of titanium mesh cages（TMC）after anterior cervical corpectomy and fusion（ACCF）,and discuss the influence of TMC subsidence on clinical curative effect.Methods From May 2003 to August 2007,a total of 300 patients who underwent ACCF with TMC were included in the study.The risk factors for TMC subsidence were investigated including age,sex,segment of corpectomy,type of plate and using end caps or not.The influence of TMC subsidence on cervical curvature and other clinical curative effect was also evaluated.Results After one-year follow-up,TMC subsidence occurred in 239（79.7%）cases,including mild subsidence（1-3 mm）in 182（60.7%）and severe subsidence（3 mm）in 57（19.0%）.Compared to one-segment corpectomy,two-segment corpectomy was more susceptible to result in severe subsidence.JOA recovery rate of severe subsidence was significantly lower than that of no subsidence.Severe subsidence increased the incidence of some complications,including neck and shoulder pain,neurological deterioration and instrument failure.Conclusion TMC subsi-dence is a common phenomenon after ACCF.Multi-segmental corpectomy is a unique risk factor for severe subsidence in this study,which may lead to worse clinical results and complications.