颈前路钛网植骨融合术后钛网沉陷的原因分析  

Subsidence of titanium mesh after anterior cervical corpectomy and reconstruction with titanium mesh and bone graft

作　　者：郭永飞[1] 陈德玉[1] 徐建伟[1] 王新伟[1] 王良意[2] 何志敏[1] 陈宇[1] 袁文[1] 贾连顺[1] 

机构地区：[1]第二军医大学附属长征医院骨科,上海市200003 [2]武警上海总队医院骨科,上海市201103

出　　处：《中国脊柱脊髓杂志》2005年第7期409-413,共5页Chinese Journal of Spine and Spinal Cord

基　　金：上海市科学技术委员会基金资助项目(编号024419126)

摘　　要：目的:探讨颈前路钛网植骨融合术后钛网发生沉陷的原因及其对颈椎曲度和临床疗效的影响,并提出相应改善对策。方法:对24例颈前路钛网植骨融合术后钛网发生沉陷的病例行影像学检查,观察骨密度、钛网修剪及放置情况、钢板类型、终板处理情况等,JOA评分法评价手术前后及钛网沉陷后神经功能改变情况,测量手术前后及钛网沉陷后颈椎曲度“D”值并行统计学比较。结果:钛网发生沉陷的原因主要为钛网修剪放置不当、终板刮除过多、术中过度撑开、骨密度下降、选用钢板不适当。术后JOA评分平均增加6.5分(P<0.01),颈椎曲度“D”值平均提高9.25±2.52mm(P<0.05),发生钛网沉陷后18例JOA评分平均增加1.8分,6例平均下降2.1分,“D”值视钛网沉陷发生部位的不同增减不一,但结果均无统计学意义。结论:颈前路钛网植骨融合术后钛网沉陷对颈椎曲度和临床疗效无明显影响;通过合理修剪、放置钛网并使用垫片、椎间适度撑开、保留相邻终板、选用全锁定钢板等措施,可有效防止术后钛网沉陷的发生。Objective：To analyse the reasons of subsidence of the mesh and to estimate its subsequent influence on cervical curve and clinical outcome after anterior cervical corpectomy and reconstruction with titanium mesh and bone graft.Method：24 cases with mesh subsidence after corpectomy were selected.The bone mineral density,plate type,the integrity of endplate and trimming ＆ placement method of the mesh,were decumented. Neurological function was estimated by JOA grade and the change of cervical curve was measured through the index of “D” value.Result：The subsidence factors include improperly trimming or placement of titanium mesh, overcurette of the endplate,overdistraction after corpectomy, osteoporosis,unsuitable plate system usage.All cases＇ JOA grades increased by 6.5 points averagely（P〈0.01） and the index of “D” value increased by 9.25±2.52mm averagely （P〈0.05） after operation.Both had no statistical significance.Conclusion：The subsidence doesn＇t make any impact on both cervical curve and clinical outcome.Mesh subsidence can be prevented effectively by rightly trimming and placement of the mesh,use of the mesh washer,moderate distraction,intact of adjacent endplate,selection of full-locked plate system.

关 键 词：颈椎 钛网 植骨 沉陷 椎体次全切除术 

分 类 号：R681.5[医药卫生—骨科学] R687.3[医药卫生—外科学]