椎前路Cage植入技术治疗多节段脊髓型颈椎病重建脊柱功能的效应(英文)

Anterior cervical interbody Cage placement for treatment of multilevel cervical spondylotic myelopathy: Reconstruction of spinal function

目的:多节段脊髓型颈椎病患者行颈前路椎间盘切除、Cage植骨融合、钢板内固定术可获得良好的椎管减压,达到脊髓减压目的,对这种患者彻底减压很重要。观察此技术的的脊柱重建功能。方法:①选择2003-04/2006-02天津医院脊柱外科住院的多节段脊髓型颈椎病患者38例,男35例,女3例;年龄43～72岁,病程0.5～5年。患者均对治疗方案知情同意。②所有患者均行前路颈椎间盘切除、Cage植入手术治疗,合并失稳者进行钛板固定,无失稳者单纯植入Cage。所采用Cage为Intromed公司方形聚醚醚酮材料Cage,钛板为Sofarmor Danek公司的Zephir钛板。采用的方形聚醚醚酮材料Cage弹性模量与骨组织接近,可透X线,便于术后观察评价植骨融合情况。Cage外形设计带有一定的角度,能更好的恢复颈椎生理前凸;表面弧度与终板一致,吻合度较高,增大了植骨融合率;表面有锯齿样防滑设计,植入后即刻稳定性较好;弹性模量介于皮质骨与松质骨之间,减少应力遮挡,减少融合器下沉,具有良好的抗腐蚀性和生物相容性。③于术前,术后2,8,24周时采用日本骨科协会评分系统分为上肢运动功能(4分)、下肢运动功能(4分)、感觉(6分)、膀胱功能(3分)进行评估,分数越高表示功能越好。术后进行查体和颈椎正侧位X射线片及MRI检查。结果:多节段脊髓型颈椎病患者38例均进入结果分析。38例患者在术后数天内均感到神经症状有明显改善,下肢肌力增加,肢体较术前轻松灵活,且伴有双上肢感觉异常好转。JOA评分由术前(9.25±1.85)分,提高到术后2周(12.4±2.08)分、术后8周13.2±2.07分、术后24周(13.8±1.67)分。结论:多节段间盘切除Cage植入可明显改善多节段脊髓型颈椎病患者运动感觉功能、减轻症状。

AIM： Anterior cervical discectomy and Cage bone graft fusion followed by steel plate internal fixation can decompress the vertebral canal and then spinal cord in patients with multilevel cervical spondylotic myelopathy. Complete decompression is very important for such patients. This study is to investigate the effect of this technique on reconstruction of spinal function. METHODS：①Thirty-eight inpatients with multilevel cervical spondylotic myelopathy admitted to Department of Spine Surgery, Tianjin Hospital between April 2003 and February 2006 were involved in this study. The involved patients, 35 male and 3 female, were aged 43-72 years, with disease course of 0.5 to 5 years. Informed consents of therapeutic regimen were obtained from all the patients.②All the patients underwent anterior cervical discectomy and cage placement operation. The patients with destabilized combination underwent titanium-plate fixation, and those with stabilized combination underwent cage implantation alone. The cage used in the experiment was made of tetragonal polyether ether ketone （Intromed Company）, and titatium-plate was Zephir plate （sofarmor Danek Company）. The elastic modulus of tetragonal polyether ether ketone Cage was similar to bone tissue and could allow X-ray pass through, which was easy for postoperative fusion of implanted bone. The outer design of Cage bone graft with certain angle could allow cervical physiological antecurvature well recover; Surface radian was the same as end plate, and good fitness contributed to the good fusion rate of bone graft; The sawtooth antiskid design on the surface provided good stability immediately after implantation; Elastic modulus was between os integumentale and cancellous bone that made stress-shielding and subsidence of fusion cage reduced, and had good anticausticity and biocompatibility. ③ The clinical results were evaluated with Japanese Orthopaedic. Association （JOA） scoring system before, 2,8 and 24 weeks after operation： upper limb motor function （4 points）, lower limb motor function （4 points）, sensation （6 points） and bladder function （3 points）. Higher scores indicated better function. Postoperatively, body examination and X-ray and MRI scanning of anteroposterior cervical vertebra were performed. RESULTS： Thirty-eight patients with multilevel cervical spondylotic myelopathy participated in the final analysis. Within postoperative several days, nervous symptoms improved obviously, muscle strength of lower limb was increased, limbs were more flexible after operation than before operation, and paresthesia of two upper limbs recovered in 38 patients. JOA was a score of （9.25±1.85） before operation, and it was （12.4±2.08） at postoperative 2 weeks, （13.2±2.07） at postoperative 8 weeks and （13.8±1.67） at postoperative 24 weeks. CONCLUSION： Multilevel discectomy and Cage implantation obviously improve sensorimotor function and lessen symptoms of patients with multilevel cervical spondylotic myelopathy.