颈前路钢板联合钛网或椎间融合器在颈椎前路减压融合中的应用

Application of anterior cervical plate with titanium mesh or cage in anterior cervical decompression and fusion

目的探讨颈前路钢板联合钛网或椎间融合器(cage)内固定在治疗颈椎创伤、脊髓型颈椎病等疾病中的作用和疗效。方法回顾分析2008年6月~2015年6月采用颈前路钢板内固定联合钛网植骨或椎间融合器(cage)植骨治疗的47例患者的临床资料,其中颈椎骨折28例,脊髓型颈椎病17例,颈椎滑脱9例,后纵韧带骨化2例。男性28例,女性19例;年龄22~69岁,平均50.2岁。结果本组47例均获随访,随访时间10~24个月,平均18个月;植骨均已融合,无内固定物松动,颈椎生理曲度存在,无椎间高度的丢失。患者神经功能均有不同程度恢复,JOA评分术前为7.6(3.3~10.9)分,术后6个月为10.8(7.5~14.9)分,改善率为(57.8±9.7)%;术后12个月为11.2(7.9~15.4)分,改善率为(59.8±9.5)%;术后6、12个月与术前比较差异有统计学意义(P<0.01),术后6个月与12个月比较差异无统计学意义(P>0.05)。影像学检查38例(80.1%)植骨患者植骨融合情况,结果显示无内固定物松动,颈椎生理曲度存在,无椎间高度的丢失。术后6个月47例全部植骨融合。结论颈前路钢板内固定联合钛网植骨或椎间融合器(cage)植骨,术后可即刻获得稳定,无需行石膏外固定,明显提高了植骨融合率。手术操作简单,并发症少,具有显著的优越性。

Objective To explore the function and efficacy of anterior cervical plate with titanium mesh or cage in the treatment of cervical spine trauma, cervical spondylosis and other diseases. Methods The clinical data of 47 cases [28 males and 19 females with an average age of 50. 2 （22-69） years] from Jun. 2008 to Jun. 2015 treated by anterior cervical plate with titanium mesh or cage for cervical spine trauma, cervical spondylosis and other diseases was retrospectively analyzed. Among these cases ,28 cases were cervical spine trauma, 17 eases were cervi- cal myelopathy ,9 cases were cervical spondylolisthesis and 2 cases were ossification of the posterior longitudinal liga- ment. Results All 47 patients were followed up for 10 to 24 months （ 18 on average）. Patients received neural functional recovery to different extent. The JOA scores of preoperative ,6 months after the operation and 12 months after the operation were 7. 6（3.3-10. 9） ,10. 8（7. 5-14. 9,and 11.2（7.9 - 15.4） ,respectively. There were significant differences between preoperatively and postoperatively （ P 〈 0. 05 ）. The recovery rates at 6 and 12 months after the operation were { 57.8 ± 9.7 ） % and （ 59. 8 ± 9. 5 ） %, respectively, without significant difference （ P 〉 0. 05 ）. There was no loosening of the internal fixation, the physiological curvature of the cervical vertebrae existed, and no loss of the intervertebral height happened. All patients with bone graft achieved fusion. Conclusion Application of anterior cervical plate with titanium mesh or cage has significant advantages,which can immediately achieve stability after surgery with no demand of external fixation. It significantly improves the fusion rate with simple operation and few complications.