颈椎前路椎体次全切除术后钛网下沉的原因分析及其对疗效的影响  

Analysis of the causes of titanium mesh depression after anterior cervical corpectomy and its influence on the curative effect

作　　者：黄笃[1] 康照利[1] 邹三明[1] 喻亮[1] HUANG Du;KANG Zhao-li;ZOU San-ming(Department of Orthopedics,Central Hospital of Xiaogan,Xiaogan,Hubei 432000,China)

机构地区：[1]湖北省孝感市中心医院骨科,湖北孝感432000

出　　处：《颈腰痛杂志》2019年第1期36-39,共4页The Journal of Cervicodynia and Lumbodynia

摘　　要：目的探讨颈椎前路椎体次全切除术后出现钛网下沉的主要原因,以及钛网下沉对手术疗效是否有所影响。方法随机选择了2013-09-2015-09行颈椎前路椎体次全切除术的51例患者,术后均获得1年以上随访,其中17例术后出现钛网下沉。依据患者术后是否出现钛网下沉,将其分为两组:下沉组和未下沉组。对两组患者的术后JOA评分(17分制)改善率进行组间对比,同时统计其性别、年龄、手术节段分布、椎体撑开角度等相关指标,进行组间单因素分析和多因素Logistic回归分析。结果:单因素分析提示,年龄、手术节段及椎体撑开角度均与术后钛网下沉的发生有明显相关性(P<0.05);多因素Logistic回归分析提示,年龄、手术节段、椎体撑开角度均为独立的危险因素。末次随访时,下沉组术后JOA评分改善率仅为(54.8±6.1)%,显著低于未下沉组的(67.2±4.3)%,差异有统计学意义(P<0.05)。结论:颈椎前路椎体次全切除术后出现钛网下沉现象受诸多因素影响,其中,年龄偏高、手术节段多、椎间撑开角度过大,均是独立的危险因素;同时,钛网下沉对术后神经功能改善有一定的不良影响,应引起临床重视。Objective To investigate the main causes of titanium mesh depression after anterior cervical corpectomy, and whether the titanium mesh had effect on the operation. Methods A total of 51 patients undergoing anterior cervical corpectomy from September 2013 to September 2015 were randomly selected. All patients were followed up for more than 1 year. Among them, 17 cases had titanium mesh subsidence. The patients were divided into two groups according to whether the titanium mesh appeared after operation: the subsidence group and the non sinking group. The improvement rate of postoperative JOA score(17 points) was compared between the two groups, and the gender, age, surgical segment distribution, vertebral distraction angle were recorded and analyzed by single factor analysis and multivariate Logistic regression analysis. Results The single factor analysis showed that both age and surgical segment and vertebral distraction angle had significant correlation with the occurrence of postoperative subsidence of titanium mesh(P<0.05). Multivariate Logistic regression analysis showed that age, surgical segment and vertebral distraction angle were independent risk factors. At the last follow-up, the improvement rate of JOA score in the subsidence group was(54.8 ±6.1)%, which was significantly lower than(67.2 ±4.3)% in the non sinking group, and the difference was statistically significant(P<0.05). Conclusion The anterior cervical corpectomy after titanium mesh subsidence phenomenon affected by many factors, among them, the high age, surgical segment and too large intervertebral distraction angle,are independent risk factors. At the same time, titanium mesh subsidence has adverse effect on the improvement of neurological function after operation, which should be paid attention during clinical process.

关 键 词：颈椎退行性疾病 颈椎前路椎体次全切除术 钛网下沉 相关因素 

分 类 号：R681.55[医药卫生—骨科学] R687.3[医药卫生—外科学]