颈椎前路手术应用端盖钛网治疗合并骨质疏松的老年脊髓型颈椎病对照研究

A comparative study between on-endcaps and non-endcaps titanium mesh cage for the treatment of elderly cervical spondylotic myelopathy complicated with osteoporosis approach for anterior cervical spine surgery

目的:比较颈前路椎体次全切除应用端盖钛网与无端盖钛网植骨融合术治疗合并骨质疏松的老年脊髓型颈椎病的影像结果及临床疗效。方法:对2011年1月至2016年1月采用颈前路单个椎体次全切除钛网植骨融合术治疗的60例合并骨质疏松老年脊髓型颈椎病患者进行回顾性分析,其中男26例,女34例,年龄68~79岁,平均75.8岁。根据术中所用钛网分为端盖钛网组(A组,32例)及无端盖钛网组(B组,28例)。通过JOA评分对两组患者的神经功能进行评定;通过X线对融合节段椎间高度及前凸角度(Cobb角)进行测量;通过CT评估钛网植骨融合率。结果:60例患者均获随访,随访时间1~2年,平均1.5年。临床疗效评价结果:A组术前JOA评分为9.3±1.7,术后1周、3个月、1年JOA评分分别为14.2±1.8、15.7±1.2、15.4±1.5;B组术前JOA评分为9.1±1.8,术后1周、3个月、1年JOA评分分别为14.5±1.3、14.9±1.7、15.2±1.6。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个月、1年两组JOA评分比较差异均无统计学意义(P>0.05)。影像学评价结果:A组术前融合节段椎间高度为(42.1±2.4)mm,术后1周、3个月、1年分别为(45.3±3.2)mm、(44.7±2.9)mm、(44.5±3.0)mm;A组术前Cobb角为(5.3±1.2)°,术后1周、3个月、1年分别为(10.3±1.9)°、(10.1±1.7)°、(9.9±1.3)°;B组术前椎间高度为(43.4±2.3)mm,术后1周、3个月、1年分别为(45.7±2.8)mm、(44.2±2.7)mm、(41.5±2.1)mm;B组术前Cobb角为(5.4±1.0)°,术后1周、3个月、1年分别为(11.2±1.8)°、(10.8±1.6)°、(7.2±1.4)°。两组术后融合节段椎间高度、融合节段Cobb角与术前比较明显提高(P<0.05)。术后1周、3个月A组椎间高度、融合节段Cobb角与B组比较差异无统计学意义(P>0.05),术后1年椎间高度、融合节段Cobb角A组均明显优于B组(P<0.05),末次随访,A组钛网沉陷率为6%,B组为18%。结论:颈前路手术应用端盖钛网治疗合并骨质疏松的老年脊髓型颈椎病患者,术后维持椎间隙高度及融合节段前凸角度方面优于无端盖钛网,端盖钛网的应用可有效降低骨质疏松患者的钛网沉陷的发生率。

Objective：To compare radiographic results and clinical effects of titanium mesh cage with two endcaps（on-endcaps titanium mesh cage） and without endcaps（non-endcaps titanium mesh cage） in anterior cervical corpectomy and fusion（ACCF） for elderly cervical spondylotic myelopathy. Methods：The clinical data of 60 patients with cervical spondylotic myelopathy underwent ACCF from January 2011 to January 2016 were retrospectively analyzed. There were 26 males and 34 females,aged from 68 to 79 years old with a mean 75.8 years old. The patients were divided into two groups according to the different titanium mesh cage,using on-endcaps titanium mesh cage（group A,32 cases） or non-endcaps titanium mesh cage（group B,28 cases）. The nerve function was evaluated by JOA score system; the height of intervertebral fusion segments and fusion segmental lordosis angle（Cobb angle） were measured by cervical lateral X-ray films,the bone graft fusion rate of titanium mesh was evaluated by CT. Results：All the patients were followed up from 1 to 2 years with an average of 1.5 years.The preoperative JOA scores of group A were 9.3 ±1.7,postoperative at 1 week,3 months,1 year were 14.2 ±1.8,15.7 ±1.2,15.4±1.5,respectively;and the preoperative JOA scores of group B were 9.1±1.8,postoperative at 1 week,3 months,1 year were 14.5 ±1.3,14.9 ±1.7,15.2 ±1.6,respectively. The postoperative JOA scores between two groups were obviously improved than that of preoperative（P〈0.05）. There was no significant difference in JOA scores of 3 time-point after operation between two groups（P〉0.05）. In the group A,preoperative intervertebral height were（42.1 ±2.4） mm,postoperative at 1 week,3 months,1 year were（45.3 ±3.2） mm,（44.7 ±2.9） mm,（44.5 ±3.0） mm,respectively; preoperative Cobb angle of fusion segments were（5.3 ±1.2）°,postopera tive at 1 week,3 months,1 year were（10.3 ±1.9） °,（10.1 ±1.7） °,（9.9 ±1.3） °,respectively. And in group B,preoperative intervertebral height were（43.4±2.3）mm,postoperative at 1 week,3 months,1 year were（45.7±2.8） mm,（44.2±2.7） mm,（41.5±2.1） mm,respectively; preoperative Cobb angle of fusion segments were（5.4±1.0） °,postoperative at 1 week,3 months,1 year were（11.2±1.8）°,（10.8±1.6）°,（7.2±1.4） °,respectively. The postoperative intervertebral height,Cobb angle of fusion segments between two groups were obviously improved than that of preoperative（P〈0.05）. There was no significant difference in intervertebral height and Cobb angle at 1 week,3 months after operation between two groups（P〉0.05）. One year after operation,intervertebral height and Cobb angle in group A was better than that of group B（P〈0.05）. Conclusion：On-endcaps titanium mesh cage is superior to non-endcaps titanium mesh cage in the maintenance of cervical intervebral height and segmental lordosis angle postoperatively at elderly spondylotic myelopathy complicated with osteoporosis. The usage of on-endcaps titanium mesh cage can effectively reduce postoperative subsidence rate.