骨小梁钽金属颈椎间融合器在颈椎病前路融合中的应用及解剖形态学特征

Application of trabecular tantalum cage in anterior cervical discectomy and fusion for cervical spondylosis and its anatomical characteristics

背景:将骨小梁钽金属颈椎间融合器用于前路融合中治疗颈椎病具有重要作用,但目前对其解剖形态颇有争议。目的:探讨骨小梁钽金属颈椎间融合器在颈椎病患者前路融合手术中的应用效果及解剖形态特征。方法:纳入颈椎病患者93例,分3组进行颈椎前路减压融合治疗:自体骨组(n=31)进行单纯自体骨植骨融合;聚醚酮组(n=31)进行聚醚酮椎间融合器联合自体骨植骨融合;骨小梁钽金属组(n=31)进行骨小梁钽金属椎间融合器联合自体骨植骨融合。记录3组围手术期并发症;治疗前及治疗后6个月,进行目测类比评分、日本骨科学会评分JOA、颈椎功能障碍指数NDI评估,采用CT观察椎间融合情况、椎间隙高度、融合节段前凸角。结果与结论:(1)3组并发症发生率比较无差异;(2)3组治疗后6个月的目测类比评分、JOA评分、NDI评分均较治疗前明显改善(P <0.05);治疗后6个月,自体骨组、骨小梁钽金属组JOA评分、NDI评分均较聚醚酮组明显改善(P <0.05),自体骨组与骨小梁钽金属组JOA评分、NDI评分比较无差异,3组间目测类比评分比较无差异;(3)3组治疗后6个月的椎间隙高度、融合节段前凸角、融合面积均较治疗前明显改善(P<0.05);治疗后6个月,自体骨组、骨小梁钽金属组椎间隙高度、融合节段前凸角、融合面积均较聚醚酮组明显改善(P <0.05),自体骨组与骨小梁钽金属组3项指标比较无差异;(4)治疗后6个月,骨小梁钽金属组椎间融合率高于自体骨组、聚醚酮组(P <0.05);(5)结果表明,将骨小梁钽金属颈椎间融合器用于颈椎病前路融合中效果理想,能实现颈椎结构重建,获得较好的稳定性,符合解剖形态学要求。

BACKGROUND:Trabecular tantalum cage plays an important role in anterior cervical discectomy and fusion(ACDF)for cervical spondylosis,but its anatomical morphology remains controversial.OBJECTIVE:To investigate the effect and anatomical characteristics of trabecular tantalum cage in ACDF for patients with cervical spondylosis.METHODS:Ninety-three patients with cervical spondylosis were enrolled,and underwent ACDF using bone autograft(n=31,autograft group),polyether ketone cage combined with bone autograft(n=31,polyether ketone group)or trabecular tantalum cage combined with bone autograft(n=31,trial group).The perioperative complications were recorded.Before and 6 months after treatment,the Visual Analogue Scale,Japanese Orthopedic Association,Neck Disability Index,intervertebral fusion,intervertebral space height,and anterior lordosis of fused segment on CT were detected.RESULTS AND CONCLUSION:(1)There was no difference in the incidence of complication among groups.(2)The Visual Analogue Scale,Japanese Orthopedic Association,and Neck Disability Index scores at 6 months after treatment in each group were significantly improved compared with baseline(P<0.05).The Japanese Orthopedic Association,and Neck Disability Index scores at 6 months after treatment in the autograft and trial groups were significantly improved compared with the polyether ketone group(P<0.05),and the scores showed no significant difference between autograft and trial groups.The Visual Analogue Scale scores at 6 months after treatment did not differ significantly among groups.(3)The intervertebral space height,anterior lordosis of fused segment,and fusion area at 6 months after treatment in each group were significantly improved compared with baseline(P<0.05).The imaging indexes in the autograft and trial groups were significantly improved compared with the polyether ketone group(P<0.05),but showed insignificant difference between autograft and trial groups.(4)At 6 months after treatment,the fusion rate in the trial group was significantly higher than that in the autograft and polyether ketone groups(P<0.05).(5)These results imply that trabecular tantalum cage applied in ACDF obtains satisfactory outcomes,and can achieve cervical reconstruction and good stability,which is accordance with the anatomical requirements.