颈前路椎体次全切除端盖与无端盖钛网植骨钢板内固定术治疗脊髓型颈椎病比较研究

Evaluation of on-endcaps titanium mesh cage versus non-endcaps titanium mesh cage for anterior cervical corpectomy and fusion

目的比较颈前路椎体次全切除端盖钛网与无端盖钛网植骨融合术对脊髓型颈椎病的治疗结果。方法对2011-01-2014-01采用颈前路钛网植骨术治疗的86例脊髓型颈椎病患者进行回顾性分析,其中端盖钛网组40例患者记为A组,无端盖钛网46例患者记为B组。影像学评价指标为椎间高度,钛网沉陷率,融合节段前凸角度(Cobb角),颈椎曲度及钛网植骨融合率;临床疗效评价指标为JOA评分和JOA评分改善率。结果 86例患者随访时间为术后1周,3月和1年。影像学测量:两组术后椎间高度、融合节段Cobb角及颈椎曲度与术前相比均有统计学意义(P<0.05)。术后1周,3月A组椎间高度、融合节段Cobb角及颈椎曲度与B组相比无明显差异(P>0.05),术后1年A组优于B组(P<0.05)。术后1年A组钛网沉陷率明显低于B组,而两组钛网植骨融合率无明显差异。临床疗效评价结果:两组术后JOA评分与术前相比均明显改善(P<0.05)。术后1周,3月及1年两组JOA评分及术后1年JOA评分改善率两组比较均无统计学差异(P<0.05)。所有患者术后1年JOA评分改善率与钛网下沉距离比较无明显相关性(P>0.05)。结论端盖钛网在术后维持椎间高度及颈椎曲度方面均优于无端盖钛网,端盖钛网的应用可有效降低钛网沉陷的发生率。

Objective To evaluate radiographic and clinical outcomes of titanium mesh cage incorporates two endcaps （on-endcaps TMC） and without endcaps （non-endcaps TMC） in anterior cervical corpectomy and fusion （ACCF）. Methods Retrospectively analyzed 86 patients with ACCF using on-endcaps TMC（group A） or non-endcaps TMC（group B） for cervical spondylotic myelopathy in this study. The radiographic indicators were intervertebral height, rate of severe subsidence （ ≥3 mm）, Cobb angle of fusion segments, cervical curvature and fusion status, and clinical efficacy was evaluated by JOA score and improvement rate of JOA score. The data of before surgery, and at one-week, three- month and one-year follow-up were recorded. Results In image data： postoperative intervertebral height, Cobb angle of fusion segments and cervical curvature in each group had significant differences compared with preoperation（P〈0.05）. At one-week and three-month follow-up, there were no significant differences in intervertebral height, Cobb angle and cervical curvature between group A and B（P〉0.05）, but there were significant differences between group A and B at one-year follow-up （P〈0.05）. At one- year follow-up, group A had a lower TMC subsidence rate compared with group B, but bone graft fusion rate was similar between group A and B （P〉0.05）. In clinical data： JOA scores were greatly improved postoperation in both two groups compared witb preoperation （P〈0.05）. JOA scores at one-week, three- month and one-year follow-up and JOA score improvement rate in group A ]lad no significant differences compared with group B （P〉0.05）. In addition, JOA score rate was not corrected with TMC suhsidence （P〉0.05）. Conclusion On-endcaps TMC is superior to non-endcaps TMC in maintenance of cervical interverlebral height and cervical curvature postoperatively. The usage of on-endcaps TMC can effectively reduce postoperative TMC subsidence rate.