老年颈椎病患者颈前路次全切应用限制性与非限制性钛板的疗效对比  

Comparison of constrained and non-constrained titanium plates in the anterior cervical corpectomy in elderly cervical spondylosis

作　　者：江立波[1] 薛恩兴[1] 吴瑞凯[1] 郑旭浩[1] 胡旭琪[1] 吴畏[1] 徐华梓[1] 

机构地区：[1]温州医学院附属第二医院骨科,温州325000

出　　处：《中华老年医学杂志》2013年第8期857-860,共4页Chinese Journal of Geriatrics

摘　　要：目的分析老年颈椎病患者的颈前路椎体次全切除钛网植骨融合内固定术中采用限制性和非限制性钛板的临床疗效和影像学变化。方法将58例行颈前路椎体次全切除钛网植骨融合内固定术的老年颈椎病患者分为限制性钛板组（30例）和非限制性钛板组（28例），比较两组的临床疗效及影像学表现。结果非限制性组与限制性组相比，末次随访时的日本矫形外科协会（JOA）评分改善率分别为（77．7±18．6）％、（75．8±23．2）％（t=0．340，P=0．735）；术后3个月，两组的融合率分别为89．3％、63．3oA（x2=5．327，P=0．021）；术后3、6、12个月，非限制性组与限制性组相比，融合节段高度的丢失增大（2．42±3．05）mm和（0．98±2．86）mm、（3．95±3．65）mm和（2．34±2．97）mm、（3．60±4．33）mm和（2．40±2．96）mm，融合节段前凸角度的丢失增大（1．64±2．33）°和（O．66±2．14）°、（2．13±3．79）°和（0．70±2．99）°、（2．39±4．26）°和（0．86±3．25）°，但是差异均无统计学意义（P〉0．05）。结论两种钛板的临床疗效差异无统计学意义，且非限制钛板有助于患者的椎间植骨的早期融合。但是非限制性钛板有可能加重老年患者的融合节段前凸角度和高度的丢失，因此老年骨质疏松患者应慎用。Objective To compare the clinical efficacy and radiologic changes between constrained and non-constrained titanium plate in anterior cervical corpectomy and fusion （ACCF） in elderly cervical spondylosis patients. Methods A total of 58 elderly cervical spondylosis patients who underwent ACCF were divided into group 1 （patients treated with constrained titanium plates, n =30） and group 2 （patients treated with non-constrained titanium plates, n= 28）. The Japanese Orthopedic Association （JOA） score, fusion rate, the loss of segmental height and cervical lordosis were recorded. The clinical efficacy and imaging features were compared between the two groups. Results The improvement rate of JOA score had no significant differences between group 1 and group 2 （（77.7~18.6）° vs. （75.8＋23.2）%, t=0.340,P〉0.05]. At 3 months after operation, the fusion rate was higher in group 2 than in group 1 （89.3% vs. 63.3%, x2=5.327,P〈0.05）. At 3, 6 and 12 months after operation, there were no significant differences in the loss of segmental cervical height and lordosis between group 1 and group 2 〈（2.42±3.05）mm vs. （0.98±2.86）ram, （3.95±3.65）mmvs. （2.34±0.97）mm, （3. 60±4. 33）mm vs. （2.40±2.96）mm, （1.64±2.33）° vs. （0.66 ±2.14）%, （2.13±3.79）% vs. （0.70±2.99）%, （2.39±4.26）° vs. （0.86±3.25）°, respectively, all P 〉0.05]. Conclusions The clinical efficacy is similar in ACCF with the two types of titanium plates. The non-constrained titanium plate can increase the fusion rate in early time, but may aggravate the loss of segmental cervical height and lordosis, which should be used with caution in elderly osteoporosis patients.

关 键 词：颈椎病 椎间盘切除术 经皮 

分 类 号：R687.3[医药卫生—骨科学]