3D打印人工椎体与钛笼在颈椎前路椎体次全切除减压植骨融合术中应用的效果比较

Comparative study on the effects of 3D-printed artificial vertebral body and titanium cage in anterior cervical corpectomy and fusion surgery

目的:评估3D打印人工椎体与传统钛笼在颈椎前路椎体次全切除减压植骨融合术(anterior cervical corpectomy and fusion,ACCF)中应用的临床效果.方法:回顾性分析2017年6月~2020年6月于承德医学院附属医院脊柱外科行单椎体ACCF的50例脊髓型颈椎病患者,其中25例术中应用3D打印人工椎体(观察组),25例术中应用传统钛笼植骨(对照组).记录两组患者手术时间、术中出血量、C型臂X线机透视次数及随访时间.术前、术后3天、术后3个月及末次随访时在颈椎侧位X线片上测量椎体次全切除节段椎间高度(H1、H2)、C2-7 Cobb角、C2-7矢状面轴向距离(C2-7 sagittal vertical axis,C2-7 SVA)及T1倾斜角,比较两组患者各时间点的影像学参数;应用日本骨科协会(Japanese Orthopaedic Association,JOA)评分评价神经功能,应用疼痛视觉模拟(visual analogue scale,VAS)评分评价颈部疼痛.根据Kandziora标准判断植骨融合情况.结果:所有患者均获得随访,观察组随访时间12~33个月(24.16±4.95个月);对照组随访时间12~33个月(22.60+5.91个月),两组患者随访时间比较无统计学差异(P>0.05).两组患者手术时间、术中出血量和C型臂X线机透视次数均无显著性差异(P>0.05);两组患者术后各时间点的JOA评分和VAS评分较术前均有明显改善,差异均有统计学意义(P<0.05),两组间同时间点比较无统计学差异(P)>0.05);术后两组患者各时间点的椎体间高度、C2-7 Cobb角、C2-7 SVA及T1倾斜角与术前相比均有明显改善(P<0.05),两组间术前及术后3天比较无显著性差异(P>0.05),术后3个月及末次随访时两组间比较有统计学差异(P<0.05).末次随访时观察组19例人工椎体存在下沉,下沉距离为0.1~0.9mm,无严重下沉患者;对照组20例钛笼下沉,下沉距离为1.3~3.5mm,有4例严重下沉患者;观察组人工椎体下沉距离小于对照组钛笼下沉距离,差异有统计学意义(P<0.05).末次随访所有患者均实现骨性融合.结论:脊髓型颈椎病患者行ACCF时应用3D打印人工椎体和传统钛笼植骨均可恢复椎体间高度,重建颈椎稳定性及颈椎生理曲度;3D打印人工椎体能够减缓术后支撑假体的沉降,进而维持减压椎体间高度.

Objectives:To evaluate the clinical effects of 3D-printed artificial vertebral body and titanium cage in anterior cervical corpectomy and fusion(ACCF).Methods:A retrospective analysis was performed on 50 patients with cervical spondylotic myelopathy who underwent ACCF of single vertebra in the Spinal Surgery Department of the Affiliated Hospital of Chengde Medical College from June 2017 to June 2020.Among them,25 patients were treated with 3D-printed artificial vertebral body(observation group)and 25 patients were treated with traditional titanium cage bone grafting(control group).The operative time,intraoperative blood loss,C—arm fluoroscopy times and follow-up period were recorded.Intervertebral height(Hl,H2),C2-7 Cobb,C2-7 sagittal vertical axis(C2-7 SVA)and T1 tilt angle of subtotal resection segment were measured on lateral cervical X-ray films before operation,3 days after surgery,3 months after surgery and at the last follow-up.The changes of imaging parameters at each time point were compared between the two groups.Neurologic function was evaluated by Japanese Orthopaedic Association(JOA)score and neck pain was evaluated by visual analogue scale(VAS).Bone graft fusion was evaluated according to Kandziora criteria.Results:All patients were followed up for 12 to 33 months,averaged 24.16±4.95 months(observation group)and 22.60±5.91 months(control group)with no statistical difference between the two groups(R>0.05).There were no significant differences in operative time,intraoperative blood loss and C-arm fluoroscopy frequency between the 2 groups(R>0.05).The JOA score and VAS score of both groups at each time point after surgery were significantly improved compared with those before surgery,with statistical significance(P<0.05),but there was no statistical difference between the two groups at the same time point(P>0.05).Intervertebral height,C2-7 Cobb,C2-7 SV A and T1 tilt angle of the 2 groups at each time point after surgery were significantly improved compared with those before surgery(P<0.05),there were no significant differences between the 2 groups before surgery and at 3 days after surgery(P>0.05),and there were statistical differences between the 2 groups at 3 months after surgery and the last follow-up(P<0.05).At the last follow-up,there was sinking of the artificial vertebral body in 19 patients of the observation group,with a sinking distance of 0.1-0.9mm,and none occurred serious sinking.In the control group,20 cases occurred titanium cage subsidence at a sinking distance of 1.3-3.5mm,and 4 cases sank seriously.The sinking distance of the artificial vertebral body in the observation group was less than that in the control group,and the difference was statistically significant(P<0.05).Bone fusion was achieved in all patients at the last follow-up.Conclusions:In ACCF surgery for patients with cervical spondylotic myelopathy,both 3D-printed artificial vertebral body and traditional titanium cage bone grafting can restore the intervertebral height,reconstruct the cervical stability and cervical physiological curvature.The 3D-printed artificial vertebra can slow down the settlement of the postoperatively supported prosthesis,thus maintaining the height between the decompressed vertebrae and the physiological curvature of the cervical spine.