目的 探讨3D打印椎间融合器应用于颈椎前路减压椎间融合术（anterior cervical discectomy and fusion，ACDF）治疗单节段颈椎病的临床疗效和矢状位平衡。 方法 回顾性分析我院2017年6月~2019年6月行单节段ACDF手术的60例颈椎病患者，其中实验组30例应用3D打印钛合金椎间融合器，对照组30例应用聚醚醚酮（PEEK）椎间融合器。分别记录两组患者手术指标、平均住院日、各阶段随访的VAS、JOA评分和相关影像参数，评估疗效和矢状位平衡。 结果 实验组手术时间（76.1±5.7）min和术中出血量（33.7±6.5）mL，均少于对照组的（85.5±6.5）min和（45.3±5.8）mL，差异有显著性（P<0.05）。两组患者术前JOA和VAS评分分别为（4.8±2.3）分、（7.7±1.5）分和（5.1±2.1）分、（8.0±1.6）分，术后末次随访分别为（15.5±1.3）分、（1.0±0.6）分和（14.3±1.5）分、（1.8±0.7）分，两项评分较术前均有明显改善，差异有显著性。组间对比末次随访数据显示统计学差异（P<0.05）。术前两组各影像参数组间比较无统计学差异（P>0.05），术后各时段的影像参数与本组术前相比有明显改善（P<0.05），末次随访时实验组与对照组椎间高度分别为（6.8±1.3）mm、（5.7±1.4）mm，椎间角度分别为（7.3±1.3）°、（6.0±1.4）°，C2~7 Cobb角分别为（23.6±5.3）°、（19.3±5.4）°，T1倾斜角分别为（24.3±2.2）°和（20.3±2.6）°，实验组明显高于对照组，差异存在统计学意义（P<0.05）。 结论 3D打印钛合金椎间融合器应用于ACDF手术治疗单节段颈椎病临床效果良好，在改善并维持椎间高度、颈椎矢状位平衡等方面优于传统PEEK融合器。
Abstract
Objective To investigate the clinical efficacy and sagittal balance changes of a 3D-printed interbody fusion cage in the treatment of single-level cervical spondylosis during anterior cervical discectomy and fusion (ACDF). Methods Retrospective analysis of 60 patients with cervical spondylosis who underwent single-segment ACDF operation in our hospital from June 2017 to June 2019 was performed, thereinto, the experimental group consisted of 30 patients with 3D printed titanium interbody fusion apparatus, the control group was 30 patients treated with polyether ether ketone (PEEK) interbody fusion cage. Related indexes, average length of stay, VAS score at each follow-up period, JOA score and related image parameters, evaluation of curative effect and sagittal balance changes during surgery in the two groups were recorded. Results The operative time of the experimental group was (76.1±5.7) min and the intraoperative blood loss was (33.7±6.5) ml, both of which were lower than the control group ((85.5±6.5) min and (45.3±5.8) mL), the difference was statistically significant (P<0.05). Preoperative JOA and VAS scores of two groups were (4.8±2.3) points, (7.7±1.5) points and (5.1±2.1) points, (8.0±1.6) points respectively. The last postoperative follow-up JOA and VAS scores of two groups were (15.5±1.3) points, (1.0±0.6) points and (14.3±1.5) points, (1.8±0.7) points, respectively, the two scores were significantly improved compared with those before surgery, and the differences were statistically significant (P<0.05). Between groups, the last follow-up data showed statistical difference (P<0.05). There was no significant difference in comparison of preoperative imaging parameters between the two groups (P>0.05). Compared with the group before operation, the postoperative image parameters of each period were significantly improved (P<0.05). At the last follow-up, intervertebral height and angle, C2-7 Cobb angle and T1 inclination angle between experimental group and control group were (6.8±1.3, 5.7±1.4) mm, (7.3±1.3, 6.0±1.4) °, (23.6±5.3, 19.3±5.4) ° and (24.3±2.2, 20.3±2.6) °, respectively. The experimental group was significantly higher than that of the control group, the difference was statistically significant (P<0.05). Conclusions The application of 3D printed titanium alloy interbody fusion cage in the treatment of single level cervical spondylosis in ACDF has a good clinical effect. It is superior to the traditional PEEK fusion cage in improving and maintaining intervertebral height and angle, cervical sagittal balance and other aspects.
关键词
颈椎病； /
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颈椎前路间盘切除融合术； /
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3D打印； /
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椎间融合器
Key words
Cervical spondylosis; /
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Anterior cervical discectomy fusion; /
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3D printing; /
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Intervertebral fusion cage
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基金
河北省承德市科技支撑计划项目（201904A027）
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