不同颈椎前路融合植骨92例并发症分析:钛网植骨与整块自体骨植骨比较

Bone grafting related complications in 92 patients undergoing different kinds of anterior cervical surgeries:Entire autogenous bone versus Pyramesh bone graft

背景:颈椎前路钢板能最大程度地恢复椎间隙高度,扩大椎间孔,恢复颈椎的生理性前凸,同时能够预防单纯植骨时植骨面微小活动所带来的不稳定性,增加植骨融合率。但在应用颈椎前路钢板时,仍存在不同植骨物的选择:是取整块自体骨?还是运用钛网植骨?目的:分析比较3种不同颈椎前路融合植骨相关并发症的发生情况。方法:选择92例因颈椎间盘突出导致脊髓型颈椎病而行颈椎前路减压植骨的患者,均获得随访3个月以上。所有患者均行颈椎前路减压:6例行单纯植骨,21例行椎体间自体髂骨植骨内固定(Robinson植骨),65例行椎体间钛网植骨融合内固定。观察3种不同颈椎前路融合植骨相关并发症情况。结果与结论:6例单纯植骨患者中2例发生植骨块脱出,1例发生融合节段假关节形成,1例发生髂骨供区疼痛;21例椎体间自体髂骨植骨内固定患者中6例发生椎间高度丢失,3例发生髂骨供区疼痛;65例椎体间钛网植骨融合内固定患者中11例发生内植物下沉,椎间高度丢失,1例发生内固定断裂。结果显示单纯植骨因外固定时间长、并发症多目前较少使用;自体髂骨植骨内固定存在植骨吸收和供区并发症的缺点;椎体间钛网植骨融合内固定解决了供区并发症的问题,但仍存在钛网下沉、椎间高度丢失的缺点,术后6～9个月椎间高度丢失无明显增加,已获得椎间融合,多数患者无明显不适,不需要特别处理,由于它能从根本解决植骨供区并发症的问题,因此提倡使用钛网植骨内固定进行颈椎前路减压后的重建,但要注意适应证的选择和规范的操作。

BACKGROUND：Anterior cervical plate can maximize the intervertebral space height,expand intervertebral foramen,restore cervical physiological antecurvature,prevent instability due to implant micromovement,and increase graft fusion.However,the selection of entire autologous bone or Ti-mesh bone graft remains uncertain in application of anterior cervical plate.OBJECTIVE：To compare the complications of three different intervertebral fusion methods in anterior cervical decompression surgery.METHODS：A total of 92 cases of cervical spondylotic myelopathy were treated by anterior cervical decompression and three different intervertebral fusion methods.They were followed up for at least 3 months.Of them,6 underwent bone grafting alone,21 underwent autogenous bone graft with cervical plate-screw fixation,and 65 underwent pyramesh with anterior cervical plate-screw fixation.Complications were observed in all cases.RESULTS AND CONCLUSLON：A total of 2 of 6 autogenous bone grafting cases suffered from graft bone dislocation,1 suffered from pseudoarthrosis formation,and 1 suffered from donated ilium.Six of 21 autogenous bone graft with cervical plate-screw fixation suffered from loss of intervertebral height,and 3 suffered from pain of donated ilium.Eleven of 65 pyramesh with anterior cervical plate-screw fixation suffered from titanium mesh subsidence,1 case suffered from breakage of fixation screw.Simple autogenous bone grafting surgery was rarely used due to long duration of external fixation and too much complications.Autogenous bone grafting with anterior cervical plate-screw fixation surgery has shortage of grafted bone absorption and pain of donated ilium.Pyramesh with anterior cervical plate-screw fixation surgery overcomes the shortage of donated iliac pain,but remains the shortage of titanium mesh subsidence and lose of intervertebral height.