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

蒲志超; 马向阳; 杨进城; 夏虹; 吴增晖; 尹庆水; 艾福志; 王建华

doi:10.13418/j.issn.1001-165x.2017.01.016

中国临床解剖学杂志 ›› 2017, Vol. 35 ›› Issue (1) : 78-84. DOI: 10.13418/j.issn.1001-165x.2017.01.016

临床研究

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

蒲志超¹，　马向阳¹，　杨进城²，　夏虹²，　吴增晖²，　尹庆水²，　艾福志²，　王建华²

作者信息 +

Comparative study on the application of two kinds of supports in anterior cervical subtotal corpectomy and fusion of cervical spondylotic myelopathy

PU Zhi-chao¹, MA Xiang-yang¹, YANG Jin-cheng²，XIA Hong², WU Zeng-hui², YIN Qing-shui²，Ai Fu-zhi², Wang Jian-hua²

Author information +

文章历史 +

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、C2～7 Cobb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(P > 0.05)。两组患者术后即刻与术前D值差值有统计学意义(P <0.05)，在术后3、6、9个月融合节段前后高上差异有统计学意义（P<0.05），融合率上差异无统计学意义（P > 0.05），而在术后6、9个月沉降率上差异有统计学意义（P < 0.05），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 the effects of titanium mesh and nano-hydroxyapatite / polyamide 66 (n-HA / PA66) cervical spine bone grafts on cervical spine subtotal resection, decompression fusion, anterior titanium screw fixation, Recovery and maintenance of cervical curvature, intervertebral height and fusion rate, the settlement rate differences.　Methods　Anterior cervical decompression and fusion were performed in 75 patients with cervical spondylotic myelopathy of two adjacent segments. Forty patients underwent titanium mesh support bone grafting and 35 patients received implantation of nano-hydroxyapatite / polyamide 66 (n-HA / PA66) into the cervical spine. The operative time, intraoperative blood loss, length of hospital stay, JOA score, curvature of cervical vertebrae, height of intervertebral fusion and bone fusion were compared between the two groups. Cobb angle, C2～7 Cobb angle, and D value of the cervical spine were measured before and after the operation, 3,6,9 months follow-up, (HAB) and posterior edge height (HPB) were measured to evaluate the fusion settlement of the support. The differences between the parameters were analyzed by the paired t test.　Results　All patients were followed up for 9-24 months (mean 16.7 months). The JOA score of the two groups was significantly higher than that of the preoperative group. There was no significant difference in the JOA scores between the two groups (P> 0.05). There was significant difference between the two groups (P <0.05). There was significant difference between the two groups (P<0.05), and there was significant difference (P <0.05) between the two groups at 3, 6, 9 months postoperatively, (P> 0.05), but there was significant difference in the settlement rate at 6 and 9 months after operation (P<0.05). There was obvious early subsidence in the titanium mesh group, which affected the fusion segment vertebrae Between the height. Conclusion Nano-hydroxyapatite / polyamide 66 (n-HA / PA66) cervical support has the advantages of improved fusion rate and less complication compared with titanium mesh support bone graft. It can effectively maintain cervical curvature and intervertebral heightand is an ideal support for bone graft material.

导出引用

蒲志超,马向阳,杨进城,夏虹,吴增晖,尹庆水,艾福志,王建华. 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[J]. 中国临床解剖学杂志. 2017, 35(1): 78-84 https://doi.org/10.13418/j.issn.1001-165x.2017.01.016

PU Zhi-chao, MA Xiang-yang, YANG Jin-cheng，XIA Hong, WU Zeng-hui, YIN Qing-shui，Ai Fu-zhi, Wang Jian-hua. Comparative study on the application of two kinds of supports in anterior cervical subtotal corpectomy and fusion of cervical spondylotic myelopathy[J]. Chinese Journal of Clinical Anatomy. 2017, 35(1): 78-84 https://doi.org/10.13418/j.issn.1001-165x.2017.01.016

参考文献

[1] 杨朝晖，吴险峰，邹磊. 前路减压植骨融合内固定术治疗颈椎间盘突出症的疗效分析[J]. 安徽医学， 2013，34(1)：22-24.
[2] 陈剑平，陈宗雄. 颈前路钢板和钛网联合cage治疗多节段颈椎病[J].中国骨与关节损伤杂志，2012，27(5)：428-429.
[3] Ugokwe KT, Kalfas IH, Mroz TE, et al. A review of the utility of obtaining repeated postoperative radiographs following single-level anterior cervical decompression, fusion, and plate placement[J]. Neurosurg Spine, 2008，9(2):175-179.
[4] Laurie SW，Kaban LB，Mulliken JB，et a1．Donor-site morbidity after harvesting rib and iliae bone[J]．Plast Reeonstr Surg，1984，73(6)：933-938．
[5] Eppley BL，Pietrzak WS，Blanton MW．Ailograft and alloplastie bone substitutes：a review of science and technology for the cranlomaxillofaeial surgeon [J]．Craniofae Surg，2005，16(6)：98l-989．
[6] Das K, Couldwell WT, Sava G, et al. Use of cylindrical titanium mesh and locking plates in anterior cervical fusion. Technical note[J]. Neurosurg Spine, 2001，94 (1 Suppl):174-178.
[7] 孟纯阳, 安洪, 蒋电明, 等. 新型纳米骨重建和修复材料羟基磷灰石/聚酰胺体内植入的生物相容性及安全性[J]. 中国临床康复, 2004, 8(29): 6330-6333.
[8] Wang X, Li Y, Wei J, et al. Development of biomimetic nano-hydroxyapatite/poly (hexamethylene adipamide) composites[J]. Biomaterials, 2002, 23(24): 4787-91.
[9] 杨朝垒，王利民，刘屹林，等.钛质外科网和纳米仿生骨在颈椎前路减压融合中的应用[J]．中国组织工程研究与临床康复，2011，15(3)：413-414.
[10] Park Y, Maeda T, Cho W, et al. Comparison of anterior cervical fusion after two-level discectomy or single-level corpectomy:sagittal alignment,cervical lordosis, graft collapse,and adjacent-level ossification[J]. Spine, 2010，10(3): 193-199.
[11]吕碧涛，袁文，王新伟，等. 钛质外科网和自体髂骨块在颈椎前路减压融合术中应用的对比性研究[J]. 中国脊柱脊髓杂志，2004，14(7)：399-402.
[12]陈育岳，隋文渊，尹庆水，等. 椎体次全切除减压植骨融合术与经椎间隙减压植骨融合术对颈椎曲度的影响及疗效比较[J]. 广东医学，2010，33(10)：1453-1455.
[13] Yonenobu K, Abumi K, Nagata K, et al. Interobserver and intraobserver reliability of the japanese orthopaedic association scoring system for evaluation of cervical compression myelopathy[J]. Spine (Phila Pa 1976). 2001，26(17):1890-1894.
[14] 修鹏，刘立岷，宋跃明，等.纳米羟基磷灰石／聚酰胺66椎体支撑体在脊髓型颈椎病前路手术重建中的应用[J]. 中国骨与关节外科，2009，2(5)：348-349.
[15] Fraser JF, Härtl R. Anterior approaches to fusion of the cervical spine:a metaanalysis of fusion rates[J]. Neurosurg Spine，2007，6(4):298-303.
[16] Hwang SL, Lee KS, Su YF, et al. Anterior corpectomy with iliac bone fusion or discectomy with interbody titanium cage fusion for multilevel cervical degenerated disc disease[J]. Spinal Disord Tech，2007，20(8):565-570.
[17]Currier BL, Papagelopoulos PJ, Neale PG, et al. Biomechanical evaluation of new posterior occipitocervical instrumentation system[J]. Clin Orthop Relat Res，2003，(411):103-115.
[18]Younger EM, Chapman MW. Morbidity at bone graft donor sites[J]. Orthop Trauma，1989，3(3):192-195.
[19]Thalgott JS, Xiongsheng C, Giuffre JM. Single stage anterior cervical reconstruction with titanium mesh cages, local bone graft, and anterior plating[J]. Spine， 2003，3(4):294-300.
[20] Ikenaga M, Shikata J, Tanaka C. Long-term results over 10 years of anterior corpectomy and fusion for multilevel cervical myelopathy[J]. Spine (Phila Pa 1976)，2006，31(14):1568-1574.
[21] Gok B, Sciubba DM, McLoughlin GS, et al. Surgical treatment of cervical spondylotic myelopathy with anterior compression: a review of 67 cases[J]. Neurosurg Spine，2008，.9(2):152-157.
[22] Kanayama M, Hashimoto T, Shigenobu K,et al. Pitfalls of anterior cervical fusion using titanium mesh and local autograft[J]. Spinal Disord Tech， 2003，16(6):513-518.
[23] Thongtrangan I, Balabhadra RS, Kim DH. Management of strut graft failure in anterior cervical spine surgery[J]. Neurosurg Focus，2003，15(3):E4.
[24]郭永飞，陈德玉，徐建伟，等. 颈前路钛网植骨融合术后钛网沉陷的原因分析[J]. 中国脊柱脊髓杂志，2005，15(7)：411-412.
[25]Daubs MD. EarIy failures following cervical copectomy reconstruction with titanium mesh cages and anterior plating[J]. Spine (Phlla Pa 1976)，2005，30 (12):1402-1406.
[26]郭永飞，陈德玉, 陈宇，等. 颈前路术后钛网下沉对颈椎曲度和手术疗效的影响[J]. 中国骨与关节损伤杂志，2006，21(9)：681-683.
[27] 王学江,李玉宝. 羟基磷灰石纳米针晶与聚酰胺仿生复合生物材料研究[J]. 高技术通讯, 2001, 11(5):1-5.
[28] Wang H, Li Y, Zuo Y, et al. Biocompatibility and osteogenesis of biomimetic nano-hydroxyapatite/polyamide composite scaffolds for bone tissue engineering[J]. Biomaterials， 2007，28(22):3338-3348.