纳米羟基磷灰石/聚酰胺66支撑体在脊髓型颈椎病前路手术不同重建方式中应用价值

Application of nano-hydroxyapatite/polyamide 66 support in different reconstruction methods of anterior approach for cervical spondylotic myelopathy

目的探讨行单节段颈椎椎体次全切除融合(anterior cervical corpectomy and fusion, ACCF)和两节段颈椎间盘切除融合(anterior cervical discectomy and fusion, ACDF)术的脊髓型颈椎病患者采用纳米羟基磷灰石/聚酰胺66(nano-hydroxyapatite/polyamide 66, n-HA/PA66)支撑体重建椎间关节的效果。方法脊髓型颈椎病患者80例,均采用n-HA/PA66支撑体重建椎间关节,根据手术方式分为ACCF组44例和ACDF组36例,ACCF组进行单节段ACCF术,ACDF组进行两节段ACDF术。比较2组术中出血量和手术时间。随访14~40个月,评估术前和末次随访时JOA评分,比较JOA改善率。测量2组术前、术后及末次随访时融合节段的高度、前凸角度,比较末次随访时椎间融合率、支撑体沉降率、融合节段角度丢失和高度丢失程度。结果 ACCF组术中出血量[(253.4±61.2)mL]多于ACDF组[(160.1±58.2)mL](P<0.05),手术时间[(143.3±25.0)min]长于ACDF组[(104.1±21.7)min](P<0.05),随访时间[(28.2±7.7)个月]和JOA改善率[(77.3±22.1)%]与ACDF组[(27.6±8.7)个月、(81.6±15.3)%]比较差异无统计学意义(P>0.05);ACCF组术前、术后及末次随访时融合节段高度[(44.8±3.1)、(48.7±2.5)、(46.3±2.5)mm]和前凸角[(7.6±6.9)°、(16.2±6.9)°、(11.3±6.6)°]与ACDF组[(44.8±3.2)、(48.6±2.7)、(46.8±2.8)mm,(6.5±8.1)°、(15.2±7.0)°、(12.7±6.7)°]比较差异均无统计学意义(P>0.05);2组术后融合节段高度均高于术前和末次随访时(P<0.05),融合节段前凸角均大于术前和末次随访时(P<0.05);2组末次随访时融合节段高度均高于术前(P<0.05),融合节段前凸角均大于术前(P<0.05)。ACCF组患者椎间融合时间长于ACDF组(P<0.05),融合节段前凸角度丢失和高度丢失大于ACDF组(P<0.05),支撑体沉降率和椎间融合率与ACDF组比较差异无统计学意义(P>0.05)。结论两节段ACDF手术创伤小,在融合节段前凸角和高度的维持上优于单节段ACCF。n-HA/PA66支撑体在颈椎ACCF及ACDF手术椎间重建中具有融合率高、沉降率低的优点,是一种可靠的重建材料。

Objective To evaluate the efficacy of nano-hydroxyapatite/polyamide 66(n-HA/PA66) support on reconstructions in patients undergoing anterior cervical corpectomy and fusion(ACCF) and anterior cervical discectomy and fusion(ACDF) of anterior approach for cervical spondylotic myelopathy. Methods Eighty patients with cervical spondylotic myelopathy underwent reconstruction with n-HA/PA66 support for the intervertebral space, and were divided into ACCF group(n=44) and ACDF group(n=36). ACCF group received single-level ACCF and ACDF group received two-level ACDF procedures. The intraoperative blood loss and operation lasting time were compared between two groups. All patients were followed up for 14 to 40 months. The Japanese Orthopaedic Association(JOA) scores before operation and at final follow-up were evaluated, and the JOA improvement rate was compared. The height and lordosis angle of the fusion segment were measured and compared before operation, after operation and at final follow-up. The fusion rate at final follow-up, the subsidence rate of the support, the loss of the segmental angle and the height loss were calculated and compared. Results The intraoperative blood loss was more in ACCF group((253.4±61.2) mL) than that in ACDF group((160.1±58.2) mL)(P<0.05), the operation time was longer in ACCF group((143.3±25.0) min) than that in ACDF group((104.1±21.7) min)(P<0.05), and there were no significant differences in the follow-up time and the improvement rate of JOA score between ACCF group((28.2±7.7) months,(77.3±22.1)%) and ACDF group((27.6±8.7) months,(81.6±15.3)%)(P>0.05). There were no significant differences in fusion segment heights((44.8±3.1),(48.7±2.5),(46.3±2.5) mm) and lordosis angle((7.6±6.9)°,(16.2±6.9)°,(11.3±6.6)°) in ACCF group compared with those in ACDF group((44.8±3.2),(48.6±2.7),(46.8±2.8) mm;(6.5±8.1)°,(15.2±7.0)°,(12.7±6.7)°) before operation, after operation and at final follow-up(P>0.05). The heights of fusion segment in two groups were higher after operation than those before operation and at final follow-up(P<0.05), and higher at final follow-up than those before operation(P<0.05). The lordosis angle of fusion segment was larger after operation than that before operation and at final follow-up(P<0.05), and larger at final follow-up than that before operation(P<0.05).The fusion time was longer,and the lordosis angle loss and height loss were larger in ACCF group than those in ACDF group(P<0.05).There were no significant differences in the subsidence rate and fusion rate between two groups(P>0.05).Conclusion The two-level ACDF procedure has less trauma and is superior to single-level ACCF in maintaining the lordosis angle and height of the fusion segment.n-HA/PA66 support is a reliable reconstruction material with the advantages of high fusion rate and low subcidence rate in anterior cervical reconstruction.