不同颈前路椎体间融合固定术疗效评价的病例对照研究  

Case-clinical studies on three different intervertebral fusion with bone graft and internal fixation in the treatment of cervical spondylotic myelopathy

作　　者：毕大卫[1] 祖罡[2] 陈亿民[1] 王辉[1] 马海涛[1] 刘道君[1] 刘俊生[2] 朱元[2] 

机构地区：[1]杭州市萧山区第一人民医院,浙江杭州311200 [2]浙江中医药大学

出　　处：《中国骨伤》2008年第6期419-421,共3页China Journal of Orthopaedics and Traumatology

摘　　要：目的:评估颈前路椎体间3种不同植骨融合固定手术治疗脊髓型颈椎病的优劣。方法:83例需行手术治疗的脊髓型颈椎病患者(男38例,女45例,平均年龄69岁)共分3组,各以椎体间自体髂骨植骨(Robingson植骨)加前路钢板融合固定、钛网融合器(Pyramesh)加前路钢板融合固定和颈椎间植骨融合器(BAK)融合固定手术,对患者术前术后JOA评分变化及骨性愈合情况进行组间比较并分析。结果:各组术后3个月及术后2年JOA评分均明显高于术前(t=1.55,P<0.05),术后各组间JOA评分差异无统计学意义(F=2.51,P>0.05)。结论:3种不同植骨融合手术均可靠有效,Robingson植骨对颈椎稳定性和骨性融合更佳,但有增加切口和可能有取骨区并发症的缺点;BAK椎体间融合固定手术的技术要求高,临床上易发生融合器内陷和椎间隙高度丢失;Pyramesh融合加钢板固定综合了前两者多方优点,但费用稍高。Objective ：To evaluate the therapeutic effects of three different intervertebral fusion with bone graft and internal fixation in the treatment of cervical spondylotic myelopathy. Methods：In the retrospective study, 83 patients （38 males and 45 females ,with an average age of 69 years） with cervical spondylotic myelopathy were divided into three groups. The patients in three groups were treated by autogenous iliac bone grafting （Roblngson grafting） with anterior cervical plate-screw fixation, Pyramesh with anterior cervical plate-screw fixation and BAK fixation respectively. JOA scores and the bony fusion time were recorded and the results were evaluated by numeric computer system. Results：The JOA scores of all the patients were higher than those before surgery （t= 1.55, P〈0.05 ）. There were no statistical difference of JOA scores in the three groups （F=2.51, P〉 0.05 ）. Conclusion： It is concluded that internal fixation of the three types is promising to the treatment of cervical spondlotic myelopathy. Robingson grafting with anterior cervical plate-screw fixation provides good stability and bony fusion. BAK is better technically required but there was height loss in clinic. Pyramesh with anterior cervical plate-screw fixation combines the merits of both two techniques above but the cost is higher.

关 键 词：颈椎病 骨移植 骨科手术方法 病例对照研究 

分 类 号：R687.4[医药卫生—骨科学] R735.2[医药卫生—外科学]