脊髓型颈椎病应用颈椎前路钛板置入对颈椎曲度的远期影响:与单纯植骨治疗的比较

Long-term influence of anterior cervical plate fixation for cervical spondylotic myelopathy on cervical curvature:A comparison with simple bone graft

目的:评价前路钢板治疗脊髓型颈椎病的相关并发症、远期疗效及其对颈椎曲度的远期影响,并与单纯植骨治疗比较。方法:回顾分析河北医科大学第三医院2000-01/2001-06行颈前路椎体次全切除减压、取自体髂骨移植治疗脊髓型颈椎病患者70例。其中单纯植骨组30例,植骨加钛板内固定组40例(Codman钛板11例,Orion钛板17例,Caspar钛板12例)。术后患者分别在术后1周、3个月、6个月、24个月、66个月进行随访,每一次随访均拍颈椎正、侧位X射线片,部分患者行颈椎动力位X射线检查,分析患者术后植骨块骨性融合情况及融合阶段椎间高度的变化、颈椎生理曲度的改变情况。并对两组患者术后颈部轴性症状进行观察。手术疗效采用JOA评分判定。结果:术后1周随访70例、3个月随访49例、6个月随访56例、24个月随访66例、66个月随访70例。①JOA评分改善率:单纯植骨组(57.35±31.83)%,植骨加钛板内固定组(61.10±28.35)%(P>0.05)。②植骨融合率和颈椎生理曲度:植骨加钛板内固定组术后6个月内植骨融合率100%,颈椎生理曲度维持良好,较术前增加(2.51±6.75)°,无钢板和螺钉松动或断裂;单纯植骨组术后6个月内植骨融合率93.3%,颈椎生理曲度较术前减少(1.33±3.43)°,两组比较差异有显著性(P<0.01),2例术后3个月假关节形成。③椎间高度:单纯植骨组较术前下降(0.8±1.1)mm,植骨加钛板内固定组较术前增加(1.5±0.7)mm,两组比较差异有显著性(P<0.01)。④轴性症状发生率:颈部轴性症状的发生率单纯植骨组46.67%,植骨加钛板内固定组17.50%(P<0.05)。⑤材料与组织的生物相容性反应:术中所用材料均为钛合金体内植入物,与人体组织的生物相容性好,到随访结束时,无血液、免疫、组织等反应,无囊膜形成及细胞质的转变;亦无钛合金腐蚀、磨损等材料反应的发生。结论:植骨块缺乏良好的承重能力,一定应力下容易发生压缩塌陷,导致颈椎曲度丢失;前路钢板治疗脊髓型颈椎病可以有效的维持椎间高度并能很好的保持颈椎的生理曲度,减少轴性症状的发生,且相关并发症少。

AIM： To evaluate complications,prostecdtive efficacy and alignment maintenance capability associated with anterior cervical plate fixation for.cervical spondylotic myelopathy, and compare with the treatment of simple bone graft. METHODS： Totally 70 patients who underwent anterior cervical discectomy and fusion using bone graft for cervical spondylotic myelopathy were enrolled at Third Hospital of Hebei Medical University from January 2000 to June 2001. Among them, 30 patienfs were in the iliac grafting group, and 40 patients were in the plate-screw fixation group （Codman in 11 cases,Orion in 17 cases and Caspar in 12 cases）. Follow-up was performed at week 1, months 3, 6, 24 and 66 after operation respectively. Anterior and lateral X-ray was done in every follow-up in all patients, and cervical dynamic X-ray was performed in partial patients. Bone fusion, height of vertebra and change of cervical physiological curvature were analyzed after operation. The neck axial symptoms after operation were observed. Curative effect was judged by using JOA grading system. RESULTS： Postoperative 1-week follow-up was performed in 70 cases, 3-month follow-up in 49 cases, 6-month follow-up in 56 cases, 24-month follow-up in 66 cases and 66-month follow-up in 70 cases. ①The improvement rate of JOA was （57.35±31.83）% in iliac grafting group,（61.10±28.35）% in plate-screw fixation group, respectively （P 〉 0.05）. ②Within 6 months, all 40 patients with cervical plates had fusions, and the cervical lordotic alignment was increased （2.51 ±6.75）°, and without plates and bolt loose or break. Of the 30 patients without plates the cervical lordotic alignment were decreased （1.33±3.43）°（P 〈 0.01）, 2 patients had not fusions within 6 months （the fusion rate was 93.3%）. Pseudoarticulation was formed in 2 patients 3 months after operation. ③The disc height was decreased （0.8±1.1） mm in lilac grafting group and increased （1.5±0.7） mm in plate-screw fixation group （P 〈 0.01）. ④The incidence of neck axial symptom was 46.67% in the iliac grafting group and 17.50% in the plate-screw fixation group （P 〈 0.05）. ⑤The material is titanium alligation implant and has good biocompatibility. Till the end of follow-up, blood, immune or tissue reactions were not found. No peplos or cytoplasmic change was seen. Besides, titanium alligation corrosion or abrasion did not appear. CONCLUSION： The bone graft is disadvantaged of weight-bearing capability and compressed collapse can occur under a certain stress, resulting in cervical curvature loss. The use of anterior cervical plate fixation for cervical spondylosis is associated with excellent maintenance of the disc height and alignment, decrease neck axial symptom, and minimal complications.