颈椎前路钛网植骨融合术治疗多节段颈椎间盘疾患

Application of anterior cervical corpectomy and reconstruction with titanium mesh and bone graft in cervical disc disorders

目的评价颈椎前路钛网植骨融合术治疗多节段颈椎间盘疾患的临床效果。方法对68例颈椎前路钛网植骨融合术治疗颈椎间盘疾患的病例行影像学检查,观察骨密度、钛网修剪及放置情况、植骨融合、手术前后颈椎融合节段曲度高度变化情况等;JOA评分法评价手术前后神经功能改变情况。结果所有病例手术过程顺利,无死亡病例及神经损伤等并发症。术后随访6～18个月,JOA评分术前平均9.1分,术后3个月平均14.4分,平均提高5.3分,术后改善率为83.8%,手术前后神经功能差异有统计学意义(P<0.05)。患者术后轴性症状及其他不适症状均有不同程度改善,无症状加重、钛网脱出及钢板螺钉折断等。术后6个月,钛网植骨融合率达95.6%。结论颈椎前路钛网植骨融合术治疗颈椎间盘疾患时,合理应用外科技术可避免取骨区并发症,改善神经功能,融合率高。

Objective To evaluate effect of anterior cervical corpectomy and reconstruction with titanium mesh and bone graft in cervical disc disorders. Methods From October 2002 to September 2007,68 eases of anterior cervical corpeetomy and reeonstuetion with titanium mesh and bone grating were selected. The bone mineral density, the integrity of endplate and trimming ＆ placement method of the mesh were documented. Neurological function was estimated by JOA grade and the change of cervical. The key-points of anterior cervical decompression and fusion procedures were discussed. Results All patients underwent the surgery safely, and no death or neurological injury occurred. The follow-up period was 6-18 months （ average 8 months）. Preoperative and 3 months after oporation, JOA scores were 9. 1 and 14. 4 points respectively. The mean recovery rate was 83. 8 %. In term of technical result, there were great changes in all observed indexes compared pre-operation with postoperation （ P 〈 0. 05 ）. Conclusions Anterior cervical corpectomy and reconstruction with titanium mesh and bone graft can promote intervertebral body fusion and stability of the fixation segment, avoid the compalications of iliae bone grafting.