两种支撑体在脊髓型颈椎病椎体次全切减压融合术中应用的效果对比

Comparative study on the application of two kinds of supports in anterior cervical subtotal corpectomy and fusion of cervical spondylotic myelopathy

目的比较钛网与纳米羟基磷灰石/聚酰胺66(n-HA/PA66)颈椎支撑体植骨在颈椎椎体次全切、减压融合、前路钛板螺钉系统内固定术后,恢复维持颈椎曲度、椎间高度及融合率、沉降率的差异。方法 75例确诊为两个相邻节段脊髓型颈椎病的患者行颈椎前路减压融合术,40例行钛网支撑体植骨,35例行n-HA/PA66颈椎支撑体植骨,均行椎前钉板系统内固定。比较两组手术时间、术中出血量、住院时间、JOA评分、颈椎曲度变化、融合节段椎间高度及植骨融合情况。分别摄术前、术后即刻、术后3、6、9个月颈椎标准侧位X线片,测量融合节段Cobb角、C2~7Cobb角、D值评价颈椎的曲度,同时测量融合节段椎体前缘高度(HAB)、后缘高度(HPB)评价支撑体融合沉降情况,对各参数不同时期间差值分别行组间配对t检验。结果所有患者均获得随访,随访时间9~24个月(平均16.7个月)。两组患者术后的JOA评分明显高于术前,两组间JOA评分比较差异无统计学意义(P>0.05)。两组患者术后即刻与术前D值差值有统计学意义(P<0.05),在术后3、6、9个月融合节段前后高上差异有统计学意义(P<0.05),融合率上差异无统计学意义(P>0.05),而在术后6、9个月沉降率上差异有统计学意义(P<0.05),钛网组明显存在早期沉陷,影响融合节段椎间高度。结论 n-HA/PA66颈椎支撑体相对于钛网支撑植骨具有提高融合率、并发症少等优点,可以有效保持颈椎生理曲度及椎间高度,是一种较为理想的支撑体植骨材料。

Objective To compare the effects of titanium mesh and nano-hydroxyapatite / polyamide66（n- HA / PA66） cervical spine bone grafts on cervical spine subtotal resection, decompression fusion,anterior titanium screw fixation, Recovery and maintenance of cervical curvature, intervertebral height and fusion rate, the settlement rate differences. Methods Anterior cervical decompression and fusion were performed in 75 patients with cervical spondylotic myelopathy of two adjacent segments. Forty patients underwent titanium mesh support bone grafting and 35 patients received implantation of nano-hydroxyapatite/ polyamide 66（n-HA / PA66） into the cervical spine. The operative time, intraoperative blood loss, length of hospital stay, JOA score, curvature of cervical vertebrae, height of intervertebral fusion and bone fusion were compared between the two groups. Cobb angle, C27 Cobb angle, and D value of the cervical spine were measured before and after the operation, 3,6,9 months follow- up,（HAB） and posterior edge height（HPB）were measured to evaluate the fusion settlement of the support. The differences between the parameters were analyzed by the paired t test. Results All patients were followed up for 9-24 months（mean 16.7 months）.The JOA score of the two groups was significantly higher than that of the preoperative group. There was no significant difference in the JOA scores between the two groups（P〉 0.05）. There was significant difference between the two groups（P 〈0.05）. There was significant difference between the two groups（P〈0.05）, and there was significant difference（P 〈0.05） between the two groups at 3, 6, 9 months postoperatively,（P〉 0.05）,but there was significant difference in the settlement rate at 6 and 9 months after operation（P〈0.05）. Therewas obvious early subsidence in the titanium mesh group, which affected the fusion segment vertebrae Between the height. Conclusion Nanohydroxyapatite / polyamide 66（n- HA /PA66） cervical support has the advantages of improved fusion rate and less complication compared withtitanium mesh support bone graft. It can effectively maintain cervical curvature and intervertebral heightand is an ideal support for bone graft material.