两种支撑体在多节段脊髓型颈椎病前路手术重建中的比较研究

Comparative study on the application of two kinds of supporter in anterior reconstruction of multiple segmental cervical spondylotic myelopathy

目的比较纳米羟基磷灰石/聚酰胺66(n-HA/PA66)椎体支撑体和钛笼支撑体在多节段脊髓型颈椎病前路减压植骨融合术中的应用效果。方法将多节段脊髓型颈椎病84例,分为钛笼支撑体组(A组,43例)和nHA/PA66支撑体组(B组,41例),比较两组手术时间及出血量,观察两组术前及术后随访不同节段JOA评分、VAS评分、颈椎矢状位节段角及植骨融合情况。结果手术时间及出血量A组均高于B组,随访9～18个月;两组术后1、3、6个月及末次随访的JOA评分、VAS评分明显改善;术后早期(<6个月)两组间JOA评分、VAS评分无显著差异(P>0.05),末次随访时B组JOA评分高于A组、VAS评分明显低于A组(P<0.05);两组术后病变节段前凸角改善明显,两组间术前及术后早期差异不明显,但6个月后A组改善差于B组;早期植骨融合率B组高于A组、末次随访则两组无明显差异。结论两种支撑体均有术后即刻稳定颈椎功能;n-HA/PA66支撑体的应用能够缩短手术时间、减少出血量,提高植骨融合率、有效改善颈椎前凸角。

Objective To compare the effects of nano-hydroxyapatite/polyamide(n-HA/PA66)vertebral supporter and titanium cage supporter in anterior cervical corpectomy and fusion(ACCF)in patients with multiple segmental cervical spondylotic myelopathy(MSCSM).Methods The84cases of MSCSM were divided into titanium Cage Group(Group A,43cases)and n-HA/PA66Group(group B,41cases).The operation time and bleeding volume of two groups were compared.The JOA scores,VAS scores,adjacent vertebral Cobb's angle and bone graft fusion of two groups were observed before and after operation.Results The operative time and bleeding volume of Group A were higher than that in Group B.The follow-up was all9-18months in the tup groups.The JOA score and VAS score at1month,3months,6months and the last follow-up got significantly improved.There was no significant difference in VAS score and JOA score before6months postoperatively(P>0.05),but they were significantly improved in Group B than Group A at the last follow-up(P<0.05).The anterior convex horn of the two groups got improved obviously postoperatively,no difference founded between two groups at6months postoperatively,but the improving in Group A worse than in Group B.There was no significant difference in fusion between two groups at the last follow-up in spite of it was higher in Group B than in Group A at early stage(P>0.05).Conclusion Two groups can stabilize cervical structure instantaneously and postoperatively.Application of N-HA/PA66supporter can shorten operative time,reduce bleeding volume,uplift bone graft fusion rate,and improve anterior horn of cervical vertebra.