两种颈椎植骨重建钛网的临床及影像学比较

Comparison of clinical and radiological outcomes of two different cervical titanium mesh cages

[目的]颈前路椎体次全切除术中使用两种植骨重建钛网，评价两者临床及影像学效果。[方法]选取2009年6月～2009年12月行颈前路单椎体次全切手术113例。其中现有钛网63例：男33例，女30例；平均年龄52岁；新型钛网50例：男34例，女16例；平均年龄54岁。术后3、6、12个月随访颈椎x线片，测量融合节段的椎间高度和颈椎曲度，采用日本骨科学会JOA评分系统进行神经功能评价，比较两种钛网手术前后上述方面的差异。[结果]随访观察至术后12个月，现有钛网组椎间高度平均丢失（1．7±0．4）mm，颈椎曲度平均丢失4．9°±0．6°，新型钛网组椎间高度平均丢失（0．4±0．5）mm，颈椎曲度平均丢失0．9°±0．7°，两组之间差异有统计学意义（P〈0．01）；现有钛网组患者术后JOA评分神经功能恢复率平均64．9％±3．7％，新型钛网组为67．1％±3．4％，两组间差异无统计学意义（P〉0．05）。并发症：现有钛网组长期颈肩部疼痛8例、神经症状复发2例、螺钉断裂2例；新型钛网组仅有2例长期颈肩部疼痛。[结论]新型钛网在维持术后椎间高度和颈椎曲度方面优于现有钛网，而在JOA评分改善率方面优势不明显。

[ Objective] To compare the clinical and radiological outcomes of two different titanium mash cages （TMC） used in anterior cervical corpectomy and fusion （ACCF） . [ Methods] One hundred and thirteen patients undergoing ACCF surgery between June 2009 and December 2009 were evaluated retrospectively. Sixty - three patients were treated with the traditional TMC （33 males, 30 females, average age 52 years）, while 50 were treated with a new type （34 males, 16 females, average age 54 years） . Posterior X rays were taken at 3,6 and 12 months, respectively, and the segmental disc height and cervical lordosis were measured. Neural function was evaluated using JOA scoring system. [ Results] At the last follow - up at 12 months postoperatively, the traditional TMC group lost intervertebral height by （ 1.7± 0. 4 ） mm, and the lordosis was lost by 4. 9°±0. 6°, compared to （0.4 ±0. 5） mm and 0. 9° ±0. 7 in the new TMC group. The difference between the two groups was statistically significant （P 〈0. O1 ） . The improvement rates of neural fuction on JOA score were 64. 9% ±3.7% and 67.1%± 3.4% in the traditional TMC and new TMC groups respectively. However, there was no statistical difference （ P 〉 0. 05 ） . Eight patients in the traditional TMC group suffered from long - term neck pain and shoulder pain, 2 patients had recurrence of neurological symptoms, and another 2 patients suffered from screw breakage. The new TMC group only had two patients with long - term neck pain and shoulder pain. [ Conclusion ] The new type of TMC showed better maintenance of intervertebral height and cervical lordosis than the traditional TMC group, but the improvement of neural fuction on JOA score was not different between the two groups.