同种异体骨-钢板一体化治疗颈椎病

Anterior Cervical Diskectomy and Fusion Combined with Bone Allograft

目的评价同种异体骨-钢板复合体治疗颈椎病的疗效及优点。方法笔者采用颈前路椎间盘摘除或椎体次全切除减压,并测量减压窗的长、宽、高,修整同种异体骨块,与合适钢板在体外固定为一体后一次置入固定,共60例。其中,颈椎间盘突出症25例,脊髓型颈椎病20例,神经根型颈椎病15例。按JOA评分及Nurick分级评定手术效果,并依据X线平片判断椎间稳定性和融合情况。结果手术时间60～120min,平均90min;出血量50～150ml,平均100ml。本组无术中并发症,伤口均一期愈合。术后随访6～36个月,平均18个月。术后JOA评分为11～18分,平均(15.6±1.2)分。X线检查证实无骨块移位、脱落、下沉,内固定无松动,最后随访融合率为94%。结论同种异体骨-钢板一体化治疗颈椎病,既可恢复颈椎椎间高度及颈椎前凸,重建颈椎稳定性,又使手术操作简单化,缩短手术时间,减少出血、术中并发症及供骨区并发症。

Objective To evaluate the effect and advantage of anterior cervical diskectomy and fusion combined with bone allograft. Methods Sixty patients including 25 with intervetebral disc protrusion and 20 with cervical spondylitic myelopathy underwent anterior cervical diskectomy and fusion combined with bone allograft. All patients were followed up clinically and radiographically. The mean follow- up time was 18 months. JOA scores and Nurick myelopathy grading system were used for clinical assessment. Roentgenograms were analyzed to identify the stability of fused levels. Results Operation time ranged from 60 to 120 minutes with average of 90 minutes. The blooding amount was between 50 and 150 ml with average of 100 ml. In all patients, no complications occurred. The wounds were normally healed without acute or chronic infection. In statistical analysis of all patients followed up, the mean JOA scores was （9.6 ± 1.6） preoperatively and improved to （ 15.6 ± 1.2） at final follow - up （ P 〈 0.05）. The mean Nurick grades were decreased （2.8± 0.6） and （0.7 ± 0.8） before and after surgery respectively （P 〈 0.05）. The X- ray films demonstrated that no meshes were found displacing or subsiding. New bone formation occurred in the back of meshes at 6 months after surgery. The final follow- up fusion rate was 94 %. Conclusion Anterior cervical diskectomy and fusion combined with bone allograft can prevent from complications occurring in bone graft recipient and donor site, provide immediate biomechaninical stability, restore intervetebral height and lordosis, shorten operation time, and decrease blooding and complications.