同种异体腓骨环加骨赘骨在颈椎前路减压植骨融合术中应用

THE APPLICATION OF BONY ALLOGRAFT FIBULA RING PLUS OSTEOPHYTES IN ANTERIOR CERVICAL DECOMPRESSION AND FUSION

目的探讨同种异体腓骨环加自体骨赘骨在颈椎前路减压植骨融合术中应用效果。方法2009年1月-2011年12月收入我科颈椎病病人42例，均采用颈椎前路减压植骨融合钢板内固定术治疗。依据Oswestry功能障碍指数（ODI）、SF-36生活质量评分、视觉模拟疼痛量表（VAs）评分、颈椎高度和颈椎曲度恢复情况评定手术效果；依据颈椎动力位X线片判断椎间稳定性和融合率。结果获得随访34例病人，切口均一期愈合，平均住院时间8．8d，术中均未发现有椎动脉损伤、脊髓及神经根损伤、脑脊液漏、腓骨环脱落崩裂及排斥反应。病人术后各时间点椎间高度和颈椎生理曲度与术前比较，差异有显著性（F=127．70、341．48，q=3．71～45．50，P〈O．05）；病人术后3个月至末次随访时颈椎ODI、VAs评分、SF-36生活质量评分与术前比较，差异有显著性（F=128．30～403．86，q=11．55、49．87，P〈O．05）。末次随访时单、双节段植骨椎间隙骨性融合率分别为100％和94．74％。结论同种异体腓骨环加自体骨赘骨作为融合材料，在颈椎前路减压植骨融合内固定术中椎间隙骨性融合率高，临床效果满意，可在临床中应用。

Objective To assess the effect of bony allograft fibula ring plus osteophytes in anterior cervical decompression （ACD） and fusion surgery. Methods Forty-two patients with cervical spondylosis were treated with ACD and fusion with plate fixation. The efficacy of the surgery was assessed based on the Oswestry Disability Index （ODD, SF-36 quality of life score, visual analog pain scale （VAS）, disc height and cervical lordosis. The stability and synostosis rate of the cervical spine were assessed by dynamic digital X-rays. Results Follow-up of 34 patients showed their incisions healed well with an average of 8.8 days of hospital stay. No complications （such as vertebral artery injury, spinal cord and nerve root injury, cerebrospinai fluid leakage, fibula ring off crack and reject reaction） were observed. At each time point after surgery, the difference of intervertebral height and cervical lordosis was significant as From three months after surgery to the last fo compared with that before surgery （follow-up, the Oswestry Disability Indey （F=127.70,341.48;q=3.71-45.50;P〈O.05） （ODI）, VAS score and SF-36 score were sig nificanlly different as compared with that before surgery （F = 128.30-403.86;q = 11.55,49.87;P〈0.05）. At the last follow-up, the synostosis rate of the single and the double segment intervertebral was 1000% and 94.74%, respectively. Conclusion The bony allograft fibular ring plus osteophytes in anterior cervical decompression and fusion can achieved satisfactory fusion and clinical results, which applies to clinical practice.