3D打印钛合金椎间融合器置入治疗脊髓型颈椎病的临床疗效及颈椎矢状位参数变化

Clinical efficacy of 3D-printed titanium cage in the treatment of cervical spondylotic myelopathy and changes in cervical sagittal parameter

目的探讨3D打印钛合金椎间融合器(3D Cage)置入治疗脊髓型颈椎病的临床疗效及颈椎矢状位参数变化。方法回顾性研究我院2018年7月至2020年1月收治的接受单节段颈椎前路椎间盘切除植骨融合术(anterior cervical discectomy and fusion,ACDF)的脊髓型颈椎病病人39例,按照置入的融合器类型分为两组,使用3D Cage的病例纳入3D组(18例),使用聚醚醚酮椎间融合器(PEEK Cage)的病例纳入常规组(21例)。对比两组的住院时间、手术时间、术中出血量,记录术前、术后3 d及末次随访时的疼痛视觉模拟量表(visual analogue scale,VAS)评分、日本骨科协会(Japanese Orthopaedic Association,JOA)评分、颈椎功能障碍指数(neck disability index,NDI),测量术前、术后3 d及末次随访时的椎间隙高度、C2-7Cobb角、C2-7矢状面偏移距离(C2-7SVA)、T1倾斜角。结果两组的住院时间、手术时间、术中出血量、融合率以及末次随访的JOA评分、VAS评分和NDI比较,差异均无统计学意义(P均>0.05)。术后3 d,两组的椎间隙高度、C2-7Cobb角及T1倾斜角均较术前明显增加(P均<0.05)。3D组术后3 d的椎间隙高度和C2-7Cobb角分别为(9.3±0.9)mm、20.8°±7.3°,末次随访时为(8.7±0.8)mm、18.6°±7.5°,均明显高于常规组(P均<0.05);末次随访时T1倾斜角为24.2°±5.4°,明显大于常规组(P<0.05)。常规组末次随访时椎间隙高度为(7.2±0.9)mm,T1倾斜角为20.7°±5.0°,均较术后3 d时明显减小(P均<0.05)。C2-7SVA在组间及同组内各时间点的数值比较,差异均无统计学意义(P均>0.05)。结论3D Cage置入治疗脊髓型颈椎病临床疗效确切,并且在维持椎间隙高度、颈椎曲度和T1倾斜角方面更具优势。

Objective To explore the clinical efficacy of 3D-printed titanium cage(3D Cage)in the treatment of cervical spondylotic myelopathy and changes in cervical sagittal parameter.Methods A retrospective study was performed on 39 patients with cervical spondylotic myelopathy in our hospital from July2018 to January 2020,who received 1-level anterior cervical discectomy and fusion,and were divided into the 3D group(18 cases)and the conventional group(21 cases)according to the implant.The length of hospital stay,operation time and intraoperative blood loss were compared between the two groups.Japanese Orthopaedic Association scores(JOA),visual analogue scale score(VAS)as well as neck disability index(NDI)were recorded before surgery,3 days after surgery and at the last follow-up.The sagittal parameters of the cervical standing radiographs were measured including intervertebral height,C2-7 Cobb angle,C2-7 sagittal axis distance(C2-7 SVA)and T1 slope,and the clinical efficacy was evaluated.Results There were no statistically significant differences in hospital stay,operation time,intraoperative blood loss,JOA,VAS and NDI scores at last follow up between the two groups.Three days after surgery,intervertebral height,C2-7 Cobb and T1 slope were significantly increased in both groups(P<0.05).The intervertebral height and C2-7 Cobb in the 3D group were 8.7±0.8 mm,18.6°±7.5°,significantly higher than those in the conventional group(9.3±0.9 mm,20.8°±7.3°).The T1 slope(24.2°±5.4°)at the last follow-up was significantly higher than that in the conventional group(P<0.05).At the last follow-up,the intervertebral height(7.2±0.9 mm)and T1 slope(20.7°±5.0°)were significantly reduced compared with 3 days after surgery in the conventional group(P<0.05).C2-7 SVA showed no statistical difference between groups or at any time period in the same group.Conclusion 3D-printed titanium cage implantation for the treatment of cervical spondylotic myelopathy has definite clinical efficacy and advantages in maintaining the intervertebral height,cervical curvature and T1 slope.