颈椎可吸收椎间融合器治疗颈椎病对其生理前凸及椎间隙高度和功能综合恢复指标的影响:23例半年随访

Absorbable cervical fusion cage for cervical physiological antecurvature,height between vertebral body and intervertebral space and general indexes of cervica l functional recovery in cervical myelopathy patients:a 6-month follow-up in 23 case

目的:探讨应用可吸收椎间融合器在颈椎病前路减压植骨融合术后对颈椎生理曲度、椎体间隙及颈椎功能改善的作用。方法:选择2003-06/2004-03第三军医大学新桥医院骨科应用颈椎可吸收椎间融合器治疗颈椎病患者23例。男13例,女10例;年龄(56.6±10.7)岁;病程3个月～6年,其中混合型9例,神经根型14例。于术后1周和3及6个月摄颈椎正侧位X射线片,观察术后颈椎功能综合恢复情况,颈椎生理前凸及椎体间隙高度,植骨融合率。评定标准:①采用Cobb法测量颈椎生理前凸恢复情况,Cobb角前凸为(+),后凸为(-)。②X射线侧位片测量椎间隙高度。③采用Odom标准以无不适症状为优良,以不适症状间歇发作且不影响工作为良好,以日本骨科学会(JOA)17分标准评定患者颈椎功能恢复情况及改善率,以改善率≥75%优,50%～74%为良。④采用Weiler分级评估局部反应,分为0级(无临床症状,不需治疗),I级(溶骨<1mm,一般不需治疗)。⑤根据颈椎正侧位X射片植骨块和椎体终板间有连续的骨小梁、骨桥形成,判断为骨性融合情况。结果:按意向处理分析,23例均进入结果分析,并完成6个月随访。①术后1周及6个月颈椎生理前凸恢复好于术前(8.9±2.6)°,(8.7±2.4)°,(-3.5±4.1)°,(t=2.369,P<0.05),术后1周与6个月随访无明显差异。

AIM:To observe the effect of absorbable fusion cage in improving cervical phys iological curvature,intervertebral space and cervical function after cervical an terior decompression,bone graft and interbody fusion. METHODS:From June 2003 to March 2004,23 patients with cervical myelopathy were treated with absorbable fusion cage in the Department of Orthopaedics,Xinqiao H ospital,Third Military Medical University.Of the 23 patients,13 were males and 1 0 females at the age of (56.6±10.7) years with the course of cervical myelopath y from 3 months to 6 years.Cervical myelopathy was mixed in 9 cases,and nerve ro ot type in 23 cases.The X ray of lateral cervical vertebrae was photographed at postoperative 1 week,3 and 6 months to observe the general recovery of cervical function,physiological antecurvature,height of vertebral body and intervertebra l space,and fusion rate.The assessment criteria:①The Cobb angles were measured to assess the restoration of cervical physiological antecurvature by antecurvatu re of Cobb angles as (+) and post curvature as (-);②The height of vertebral body and intervertebral space were measured by;lateral X ray photographs of lat eral cervical vertebrae.③Based on Odom's standard,no adverse reaction was excel lent,intermittent adverse reaction but not influencing working was good.The 17 score standard in Japanese Orthopaedic Association(JOA) was used to assess the r ecovery of cervical function and improvement rate by equal or higher than 75%we re excellent,and 50%to 74%good.④Weiler grading was employed to assess local r eaction as 0 grade(no clinical symptom and needless to treat) and Ⅰgrade(bone f usion less than 1 mm,needless to treat commonly).⑤The osseous fusion was judged by serial bone trabecula and bone bridge between bone graft and vertebral end p lates shown by frontal and lateral X ray photographs. RESULTS:According to the intention management,all the 23 cases were included i n the result analysis and followed up.①The cervical physiological antecurvature at 1 week and 6 months after fusion recovered better than that before fusion[(8 .9±2.6)°,(8.7±2.4)°vs (-3.5±4.1)°,t=2.369,P< 0.05],but that was insignifi cantly different at 1 week and 6 months.②The height of vertebral body and inter vertebral space at postoperative 1 week and 6 months were higher than that befor e operation[(35.9±3.0) mm,(35.5±3.1) mm vs (33.2±3.1) mm,t=2.476,P< 0.05],but that was insignificantly different at 1 week and 6 months.③As for Odom's gradi ng for the recovery of cervical funxtion,the excellent rate was 91.3%(21/23) an d good rate 8.7%(2/23);17 score standard in JOA was excellent in 95.7%and goo d 4.3%.④The fusion rate was 94.4%after 3 months and 100%(23/23) after 6 mont hs.⑤No obvious local reaction was found after operation. CONCLUSION:Absorbable fusion cage is effective in recovering the cervical phys iological antecurvature,remaining the height of vertebral body and intervertebra l space in a high fusion rate,and its biomechanical intensity can maintain the f usion process and benefit postoperative recovery of cervical function.