颈椎前路椎体次全切除术后钛网下沉的原因分析

Cause analysis of titanium mesh subsidence after anterior cervical corpectomy

目的探讨颈椎前路椎体次全切除钛网植骨融合术后钛网下沉的相关因素,提出相对应的改善措施。方法回顾性分析我院96例行颈椎前路椎体次全切除减压钛网钛板植骨融合内固定手术的病例,观察其术前术后的影像学照片、术中钛网的放置情况、椎体撑开的程度、患者的骨密度等。通过JOA评分来评价手术前后患者神经功能改善情况及术后钛网下沉后神经功能的改变情况。结果 96例患者中,术后3个月随访时有18例钛网发生下沉,下沉的原因可能与骨质疏松、钛网修剪放置不当、椎体过度撑开、终板破坏过多等因素相关。通过延长佩戴颈围时间,术后6、9个月随访时,钛网下沉程度无明显加重,术后9个月复查时全部植骨融合。发生下沉的18例患者,与非下沉组相比,JOA评分结果无明显差异。结论颈椎前路钛网发生下沉是颈椎前路手术的常见并发症,一定程度上影响手术疗效,发生钛网下沉的患者,通过延长佩戴颈围,可有效阻止进一步下沉,获得满意的临床疗效。

Objective To discuss the related factors of titanium mesh subsidence after anterior cervical corpectomy titanium mesh bone graft fusion and propose relevant improving measures. Methods An retrospective analysis was made on 96 cases that had received anterior cervical cor- pectomy decompression titanium mesh or titanium plate bone graft fusion internal fixation. The imaging before and after operation and conditions like the setting condition of intraoperative titani- um mesh, the distracting degree of centrum and bone density of patients were observed. JOA score was used to evaluate the nerve function improving degree before and after operation and the nerve function change condition after titanium mesh subsidence. Results Among 96 cases, titanium mesh subsidence occurred to 18 cases during the follow-up visits at 3 months. The subsidence reason may be related to factors such as rarefaction of bone, improper placement of rarefaction of bone, excessive distraction of centrum or over much breakage of end plates. By prolonging neck circum- ference wearing time, at 6 months and 9 months, the subsidence degree of titanium mesh was not worsening. At 9 months after operation, all bone grafting fused. Compared with that of the group without subsidence, JOA score of 18 patients with subsidence had no evident statistical significance. Conclusion Anterior cervical titanium？mesh subsidence is the common complication of anterior cervical operation and it may influence the curative effect of the operation in a certain extent. As for those who have got titanium？mesh subsidence, they can prevent further subsidence by prolong-ing wearing neck circumference and obtain satisfying clinical curative effect.