颈椎前路单椎体次全切钛笼植骨融合后钛笼下沉的相关危险因素

Risk factors associated with titanium cage subsidence after anterior single-level subtotal corpectomy and interbody fusion using titanium cage

背景:颈椎前路单椎体次全切钛笼植骨融合是解除脊髓前方压迫的良好手段,阻止病情的进一步恶化,并能够在术后短时间内取得满意的疗效。但在临床观察中发现,钛笼植骨融合依然存在一定的并发症,术后钛笼下沉是最常见的并发症,临床中对于钛笼下沉发生的因素看法不一,是当前研究的热点。目的:分析颈椎前路单椎体次全切钛笼植骨融合后钛笼下沉的危险因素。方法:回顾性分析2012年3月至2016年3月在广西中医药大学第一附属医院骨科行颈椎前路单椎体次全切钛笼植骨融合的患者81例,记录患者的一般资料(性别、年龄、骨密度值、体质量指数、吸烟史和病种)、术中资料(钛笼倾斜角、钛笼深度、钉板角度和钛笼类型)和术后资料(颈托固定时间和术后工作姿势)。术后3d及末期随访(术后24个月)摄颈椎X射线片并进行比较,根据融合椎体高度降低情况分为钛笼下沉组(降低高度>2mm)和钛笼未下沉组(降低高度<2mm)。运用统计学软件对2组资料进行单因素比较,将2组间有差异的因素纳入Logistic回归分析,从而得出钛笼下沉的相关危险因素。结果与结论:(1)所有患者均完成统计,其中钛笼下沉组24例,钛笼未下沉组57例;(2)2组间比较性别、年龄、体质量指数、职业分布、吸烟史和术后工作姿势差异均无显著性意义(P>0.05);2组间骨密度值、钛笼倾斜角,钛笼深度、钉板角度、钛笼类型和术后颈托固定时间差异有显著性意义(P<0.05);(3)多因素Logistic回归分析显示,颈托固定时间过少是钛笼下沉的危险因素(P <0.05);钛笼倾斜角增加与钛笼下沉密切相关(P <0.05);(4)提示颈托固定时间与钛笼倾斜角是钛笼下沉的重要危险因素,临床中应高度重视,以减少钛笼下沉发生率,提高术后疗效。

BACKGROUND:Anterior single-level subtotal corpectomy and interbody fusion using titanium cage is a good method for anterior decompression of spinal cord,which can prevent the disease development and achieve satisfactory short-term curative efficacy.However,postoperative titanium cage subsidence is a commonest complication,and its risk factors still remain controversial,which is an issue of concern.OBJECTIVE:To study the risk factors for titanium cage subsidence after anterior single-level subtotal corpectomy and interbody fusion using titanium cage.METHODS:A retrospective analysis of 81 patients undergoing anterior single-level subtotal corpectomy and interbody fusion using titanium cage at First Affiliated Hospital of Guangxi University of Chinese Medicine from March 2012 to March 2016 was performed.The baseline data(sex,age,bone mineral density,bone mass index,history of smoking and disease type),intraoperative data(tilt angle,depth and type of titanium cage,angle of nail plate angle),and postoperative data(neck collar fixation time and postoperative working posture)were recorded.At 3 days and end of the follow-up(24 months)postoperatively,the cervical vertebrae underwent X-ray examination,and divided into titanium cage subsidence group(decreased height>2 mm)and titanium cage non-subsidence group(decreased height<2mm)according to the decreased height of the fused vertebrae.Univariate analysis between two groups was conducted on statistical software,and the factors with differences were included in the logistic regression analysis to obtain the risk factors related to the titanium cage subsidence.RESULTS AND CONCLUSION:(1)All patients completed the trial,including 24 cases of titanium cage subsidence and 57 cases of titanium cage non-subsidence.(2)The sex,age,body mass index,occupational distribution,history of smoking,and postoperative working posture showed no significant difference between two groups(P>0.05).There were significant differences in the bone mineral density,title angel,depth and types of titanium cage,angle of nail plate,and postoperative neck collar fixation time between two groups(P<0.05).(3)Multivariate logistic regression analysis showed that the short fixation time of the neck collar was the risk factor for titanium cage subsidence(P<0.05).The increase of the tilt angle of titanium cage was closely related to the titanium cage subsidence(P<0.05).(4)To conclude,the fixation time of the neck collar and the tilt angle of the titanium cage are important risk factors for titanium cage subsidence,which should be highly valued in the clinic,so as to reduce the incidence of titanium cage subsidence and improve the postoperative efficacy.