CT、MR、X线联合观察骨赘填充颈椎cage的短期融合率  

The short-term fusion rate of osteophyte filled cervical cage evaluated by a combination of CT, MR and X-ray film

作　　者：刘宁[1] 孙宇[1] 

机构地区：[1]北京大学第三医院骨科,100191

出　　处：《中华骨科杂志》2010年第4期346-350,共5页Chinese Journal of Orthopaedics

摘　　要：目的观察单纯采用椎体骨赘填充cage行颈前路椎体间融合的短期融合率。方法2007年5月至2009年5月，不同医生对103例行颈前路椎间盘切除减压、融合、钛板内固定手术的患者单纯采集手术间隙椎体前后缘的骨赘填充cage。男69例，女34例；年龄25-77岁，平均53．6岁。脊髓型颈椎病61例，神经根型颈椎病11例，交感型颈椎病1例，各种混合型颈椎病15例，各种外伤性颈脊髓病15例。单节段手术60例，双节段33例，三节段10例。术后3个月复查，以颈椎X线片、重建CT与MR三者联合观察融合效果。当CT提示融合，或虽以CT判断模糊，但X线片和MR均提示融合者，判定为融合；当CT提示未融合，或虽以CT判断模糊，但X线片或MR任何一项提示未融合者，判定为未融合。如果CT和MR均判断模糊，则按未融合计。针对双节段或三节段手术的患者，只要有一个节段未融合，即按未融合计。统计比较融合率。结果术后3个月总融合率为77．7％（80／103），单个医生最高融合率90％（18／20）。单节段融合率为80％（48／60），单个医生最高融合率88．2％（15／17）；双节段融合率为78．6％（26／33），单个医生最高融合率90％（9／10）；三节段融合率为60％（6／10），单个医生最高融合率100％（3／3）。不同节段手术的融合率间差异无统计学意义。结论对颈前路单节段或双节段手术，以骨赘填充cage进行椎体间融合可获较理想的短期融合率。Objective To observe the short-term fusion rate of using osteophyte filled cage in anterior cervical disectomy and fusion. Methods From May 2007 to May 2009, 103 patients receiving anterior cervical diseetomy, spine fusion by different surgeons were performed with cages containing exclusively autologous ostcophyte collected from both anterior and posterior vertebral edges adjacent to the intervertebral space. There are 69 males, 34 females, from 25 to 77 years of age, average 53.6 years. 60 patients received one level fusion. 33 and 10 patients received two-level and three-level fusion respectively. Patients were reviewed 3 months after operation and fusion was evaluated by X-ray film, reconstructive CT and MR. Results 1. Only 1.9% （2/103） of patients＇ X-ray films indicate non-fusion （internal fixation failure） while 31.7% （32/ 103） of patients＇ CT and 30.1% （31/103） of patients＇ MR indicate non-fusion or being confusing to make a diagnosis. 2. The diagnostic coherence between CT and MR as to evaluate fusion is good （kappa=0.686, P= 0.00）. 3. The total fusion rate was 77.7%（80/103） while the highest fusion rate achieved by single surgeon was 90%（18/20）. The total one level fusion rate was 80%（48/60） while the highest rate by single surgeon was 88.2%（15/17）. The total two-level fusion rate was 78.6%（26/33） while the highest rate by single surgeon was 90%（9/10）. The total three-level fusion rate was 60%（60/100） while the highest rate by single surgeon was 100%（3/3）. No statistic significant difference in fusion rate was found between any two of the three groups. Conclusion The method of using osteophyte filled cage can acquire ideal short-term fusion rate in one and two-level anterior cervical disectomy, fusion and plate fixation.

关 键 词：颈椎 脊柱融合术 评价研究 

分 类 号：R687.3[医药卫生—骨科学]