两种支撑体在脊髓型颈椎病椎体次全切减压融合术中应用的效果对比

发布时间：2018-09-14 16:11

【摘要】：目的比较钛网与纳米羟基磷灰石/聚酰胺66(n-HA/PA66)颈椎支撑体植骨在颈椎椎体次全切、减压融合、前路钛板螺钉系统内固定术后,恢复维持颈椎曲度、椎间高度及融合率、沉降率的差异。方法 75例确诊为两个相邻节段脊髓型颈椎病的患者行颈椎前路减压融合术,40例行钛网支撑体植骨,35例行n-HA/PA66颈椎支撑体植骨,均行椎前钉板系统内固定。比较两组手术时间、术中出血量、住院时间、JOA评分、颈椎曲度变化、融合节段椎间高度及植骨融合情况。分别摄术前、术后即刻、术后3、6、9个月颈椎标准侧位X线片,测量融合节段Cobb角、C2~7Cobb角、D值评价颈椎的曲度,同时测量融合节段椎体前缘高度(HAB)、后缘高度(HPB)评价支撑体融合沉降情况,对各参数不同时期间差值分别行组间配对t检验。结果所有患者均获得随访,随访时间9~24个月(平均16.7个月)。两组患者术后的JOA评分明显高于术前,两组间JOA评分比较差异无统计学意义(P0.05)。两组患者术后即刻与术前D值差值有统计学意义(P0.05),在术后3、6、9个月融合节段前后高上差异有统计学意义(P0.05),融合率上差异无统计学意义(P0.05),而在术后6、9个月沉降率上差异有统计学意义(P0.05),钛网组明显存在早期沉陷,影响融合节段椎间高度。结论 n-HA/PA66颈椎支撑体相对于钛网支撑植骨具有提高融合率、并发症少等优点,可以有效保持颈椎生理曲度及椎间高度,是一种较为理想的支撑体植骨材料。
[Abstract]:Objective to compare titanium mesh with nano-hydroxyapatite / polyamide 66 (n-HA/PA66) bone graft in subtotal cervical vertebra, decompression and fusion, and restore cervical curvature, intervertebral height and fusion rate after anterior titanium plate screw system fixation. The difference of settlement rate. Methods Seventy-five patients with two adjacent cervical Spondylotic myelopathy underwent anterior cervical decompression and fusion. 40 patients were treated with titanium mesh support bone graft and 35 patients with n-HA/PA66 cervical spine support bone graft. All patients were treated with anterior screw plate system internal fixation. The operation time, intraoperative bleeding volume, hospitalization time and JOA score, cervical curvature, intervertebral height of fusion segment and bone graft fusion were compared between the two groups. Standard lateral radiographs of cervical vertebrae were taken before, immediately after, 3 and 9 months after operation respectively, and the cervical curvature was evaluated by measuring the D value of the fusion segment Cobb angle C2 + 7 Cobb angle. At the same time, the fusion settlement of the support was evaluated by measuring the anterior height of the fusion segment, the height of the posterior edge of (HAB), and the height of the posterior edge. The difference between different stages of the parameters was tested by paired t test. Results all patients were followed up for 924 months (mean 16.7 months). The JOA scores of the two groups were significantly higher than those of the preoperative ones, and there was no significant difference in the JOA scores between the two groups (P0.05). The difference of D value between the two groups immediately after operation was statistically significant (P0.05). There was a significant difference in the height of fusion segment before and after 6 and 9 months after operation (P0.05), but there was no significant difference in fusion rate (P0.05), but in 69 months after operation, the sedimentation rate was lower (P0.05). The difference was statistically significant (P0.05). There were obvious early subsidence in titanium mesh group. Affect fusion level intervertebral height. Conclusion compared with titanium mesh support, n-HA/PA66 has the advantages of high fusion rate, less complications, and can effectively maintain the cervical spine physiological curvature and intervertebral height. It is an ideal bone graft material.
【作者单位】：南方医科大学研究生学院;广州军区广州总医院脊柱外科;
【基金】：广东省科技计划项目(2015B020233013)
【分类号】：R687.3

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