颈前路椎体次全切钛网植入融合术后钛网沉降的影响因素分析

发布时间：2018-07-27 14:41

【摘要】：背景:目前在临床上针对颈椎退变、创伤、肿瘤等多种疾病,颈前路椎体次全切除术被广泛应用。该手术的关键点是手术中切除椎管前方压迫,充分减压以及减压后颈椎植骨融合保证颈椎稳定性。通过手术实现脊髓减压,并酌情选择不同的融合技术,恢复维持颈椎的稳定性。手术减压完成后,钛网的原位植骨不但可以避免了供骨区并发症而且获得了较高的植骨融合率,因此在临床上被越来越多的人使用。然而,术后颈椎钛网沉降可致使颈椎生理曲度改变及椎间高度的丢失,可能造成术后患者出现神经功能损伤,甚至出现颈椎后突畸形,融合失败等并发症,甚至需要翻修手术。因此,本文对钛网沉降的相关因素进行研究并探讨其与临床效果的联系,以降低颈椎钛网沉降的发生率。目的:通过本课题的研究,探讨颈前路椎体次全切钛网植骨融合术后钛网发生沉降的相关因素及其对临床疗效的影响,并提出相应改善对策。方法:回顾性分析在2006年10月至2016年10月十年间,在我院收治的81例行颈前路椎体次全切钛网植骨融合术的患者临床资料与影像学资料。根据钛网是否发生沉降,将患者分为沉降组与非沉降组,观察分析钛网沉降与患者年龄、性别、撑开角度、钛网植入位置等相关因素的关系。并研究钛网沉降对术后神经功能恢复的影响。结果:完成随访的81例患者中,有24例(29.6%)患者术后出现钛网沉降。研究发现钛网沉降的相关因素中,两组在年龄方面的比较,差异有统计学意义。而在性别、手术节段、术前JOA评分这几个方面的差别无统计学意义。撑开角度30°者共46例,沉降组7例(15.9%),撑开角度≥30°者共35例,沉降组17例(48.6%)。椎体前缘与钛网前缘间距小于lmm者共45例,沉降组9例(20%),椎体前缘与钛网前缘间距≥1mm者共36例,下沉15例(41.7%)。两组在撑开角度和钛网植入位置两个相关因素的比较,差异存在统计学意义。通过分析患者术后的神经功能改善率,发现沉降组与非沉降组差异无统计学意义。结论:钛网沉降的因素可能包括年龄、椎间撑开角度和钛网植入位置。颈椎前路单节段椎体次全切钛网植骨融合术后,发生钛网沉降对手术效果的影响无统计学意义。掌握好恰当的手术适应证,正确处理椎体终板,进行适当的撑开角度,选用合适的钛板,选择合适的钛网并进行正确修剪,正确的钛网植入位置等可以在一定程度上预防或减轻术后钛网沉降的发生。
[Abstract]:Background: at present, anterior cervical subtotal vertebra resection is widely used for cervical degeneration, trauma, tumor and other diseases. The key point of the operation is to remove the anterior compression of the spinal canal, decompress fully and ensure the stability of the cervical spine after decompression. Spinal cord decompression was achieved by surgery, and different fusion techniques were selected to restore the stability of cervical spine. After decompression, titanium mesh bone graft in situ can not only avoid the complications of donor bone area, but also obtain a high fusion rate, so it has been used by more and more people in clinic. However, the postoperative titanium mesh subsidence can cause the cervical spine physiological curvature change and the loss of intervertebral height, which may result in postoperative patients with neurological damage, even cervical posterior process malformation, fusion failure and other complications, or even need revision surgery. Therefore, this paper studies the related factors of titanium mesh sedimentation and discusses its relationship with clinical effect in order to reduce the incidence of cervical titanium mesh subsidence. Objective: through the study of this subject, to explore the related factors of titanium mesh subsidence after anterior cervical approach subtotal titanium mesh fusion and its influence on clinical curative effect, and to put forward the corresponding improvement countermeasures. Methods: the clinical data and imaging data of 81 cases of anterior cervical vertebra subtotal titanium mesh grafting and fusion between October 2006 and October 2016 were retrospectively analyzed. The patients were divided into two groups according to whether the titanium mesh subsidence occurred. The relationship between the sedimentation of titanium mesh and the patient's age, sex, angle of distraction, placement position of titanium mesh was observed and analyzed. The effect of titanium mesh sedimentation on the recovery of nerve function after operation was studied. Results: among 81 patients, 24 (29.6%) had postoperative titanium mesh deposition. It was found that there were significant differences in age between the two groups among the relative factors of titanium mesh subsidence. There was no significant difference in gender, operative segment and preoperative JOA score. There were 46 cases with 30 掳distraction angle, 7 cases (15.9%) in the subsidence group, 35 cases (鈮，

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