预弯钛网在单节段颈前路椎体次全切除减压融合术中的应用

The application of pre-curved titanium mesh cage in one-segment anterior cervical corpectomy and fusion

目的 :评估预弯钛网在颈前路椎体次全切除减压融合术(anterior cervical corpectomy and fusion,ACCF)治疗脊髓型颈椎病中的实用性和有效性。方法:回顾性分析2016年1月～2017年1月间因脊髓型颈椎病在我科接受单节段ACCF的82例患者的病例资料,其中39例术中放置预弯钛网(预弯钛网组),43例术中放置普通直钛网(直钛网组)。对比两组患者随访期间钛网末端与椎体上终板和下终板贴合度的变化、椎体间高度变化、钛网沉降率、植骨融合率、日本骨科学会(Japanese Orthopedics Association,JOA)评分及颈项部疼痛视觉模拟评分(visual analog scale,VAS)变化情况。结果:预弯钛网组和直钛网组平均随访17.7±2.1个月和18.4±2.4个月。末次随访时,尽管两组间植骨融合率均为100%,但预弯组钛网末端与椎体上终板和下终板角度的变化(1.0°±0.7°,1.1°±0.6°)均低于直钛网组(1.9°±0.4°,2.2°±0.8°),且差异具有显著性(P<0.05);预弯钛网组椎间前、后高度的丢失和钛网下沉率分别为-1.9±1.7mm、-1.5±1.6mm及28.2%,而直钛网组分别为-2.8±1.4mm、-2.7±2.2mm及53.4%,预弯钛网组均低于直钛网组且差异均具有统计学意义(P<0.05)。末次随访时两组的JOA评分较术前均显著增加,但两组间的JOA评分、神经功能改善率均无明显统计学差异(P>0.05);末次随访时两组颈项部VAS评分较术前均显著降低,且预弯钛网组(2.5±1.2分)显著低于直钛网组(3.2±0.8分),组间比较具有统计学意义(P<0.05)。结论:在单节段ACCF手术中,预弯钛网能够与邻近椎体上下终板达到较好的贴合度,减少钛网沉降率。

Objectives： To evaluate the efficacy and safety of the application of pre-bending titanium mesh cage（TMC） in one-segment anterior cervical corpectomy and fusion（ACCF）. Methods： Patients with cervical spondylotic myelopathy undergoing one-segment ACCF from January 2016 to January 2017 in our hospital were divided into pre-bending TMC group（n=39） and straight TMC group（n=43）. Matched angle between the TMC ends and its adjacent endplates locating upper（UMD） or lower（LMD）, anterior or posterior segment height（ASH or PSH）, incidence of subsidence, rate of fusion, Japanese Orthopedic Association（JOA） and visual analog scale（VAS） score in two groups were compared. Results： The mean follow-up was 17.7±2.1 months and 18.4±2.4 months in pre-cured TMC group and straight TMC group, respectively. At final follow-up, the fusion rate in both groups was 100%, the changes of UMD/LMD in pre-bending TMC group（1.0°±0.7°/1.1°±0.6°） were significantly less than those in straight TMC group（1.9°±0.4°/2.2°±0.8°）（P〈0.05）. The ASH/PSH loss was -1.9±1.7mm/-1.5±1.6mm and the incidence of subsidence was 28.2% in pre-bending TMC group, while -1.9±1.7mm/-1.5±1.6mm and 53.4% in straight TMC group, and there were significantly differences between the two groups（P〈0.05）. There were significantly improvements in JOA and VAS scores in two groups, there were no significant differences in JOA score and neurological improvement rate between the two groups（P〉0.05）. The VAS score in pre-bending TMC group（2.5±1.2） was significantly less than that in straight TMC group（3.2±0.8, P〈0.05）. Conclusions： The application of pre-bending TMC in one-segment ACCF can achieve better fitted with the upper and lower endplates and significantly reduce the loss of ASH and PSH and the subsidence of titanium mesh.