双节段颈椎前路椎体次全切除融合术后钛笼下沉的影响因素分析

Factors influencing titanium mesh cages subsidence following two-levels anterior cervical corpectomy and fusion

目的探讨双节段颈椎前路椎体次全切除融合术（anterior cervical corpectomy and fusion,ACCF）后钛笼（titanium mesh cage,TMC）下沉的影响因素。方法回顾性分析我院2011年1月至2013年4月收治的86例应用TMC内固定行ACCF患者的颈椎正侧位片及临床资料,随访6个月,根据TMC下沉与否分为下沉组和非下沉组,分析术后TMC下沉与年龄、性别、手术节段、临床疗效、病变节段撑开角度及安置位置的相关性。结果术后6个月,86例患者中有22例发生TMC下沉（25.6%）,下沉组和非下沉组的年龄、性别、手术节段（C5～C7）、骨密度、身体质量指数（BMI）之间差异有统计学意义（P〈0.05）;两组术后日本骨科协会评分（Japanese Orthopedic Association Scores,JOA）均较术前明显改善,且非下沉组高于下沉组,差异有统计学意义（P〈0.05）,但两组融合率的差异无统计学意义（P〉0.05）;椎间撑开角度〈30°与≥30°,对下沉发生率的影响不同,差异有统计学意义（P〈0.05）;椎体前缘与钛笼前缘间距〈1 mm与≥1 mm,对下沉发生率的影响不同,差异有统计学意义（P〈0.05）。结论椎间撑开角度和安放位置可能是影响TMC术后下沉的重要因素,此外年龄、性别、手术节段（C5～C7）、骨密度、BMI对TMC下沉均有不同程度的影响。

Objective To investigate the factors influencing titanium mesh cage （TMC） subsidence following two-levels anterior cervical corpectorny and fusion （ACCF）. Methods Eighty-six patients with CSM undergoing ACCF＇and TMC from Jan. 2011 to Apr. 2013 were included in this retrospective study. The radiologic findings and clinical data were collected. All patients were follovced up for 6 months. The patients were divided into subsidence group and non-subsidence group. The subsidenc associated factors including age, sex, surgical level, clinical effectiveness, space distraction and position of cage were evaIuated retrospectively. Results Twenty-two out of 86 cases （25. 6%） had cage subsidence at 6th month after surgery. There was significant difference in age, sex, surgical level in C5- C7, BMD and BMI between two groups （P〈0. 05 for all）. The postoperative JOA score in two groups was significantly higher than that before operation （P〈0. 05）. There was no significant difference in the fusion rate between two groups （P〉0. 05）. The influence of intervertebral distract angle less than 30° or more than 30° on incidence of subsidence had significant differences （P〈0. 05）. The influence of the distance between anterior edge of cage and anterior edge of vertebral body more or less than 1 mm on incidence of subsidence had significant differences （P〈0. 05）. Conclusion Space distraction and placement were two risk factors for TMC subsidence in this study. In addition, age, gender, operation section, BMD and BMI could related to the TMC subsidence to varying degrees.