新型同种异体骨椎间融合器治疗颈椎病的临床应用  

Clinical efficiency of a new allograft cervical cage in treatment of cervical spondylosis

作　　者：方青 李洋 武文杰 刘勋 许建中 罗飞 FANG Qing;LI Yang;WU Wenjie;LIU Xun;XU Jianzhong;LUO Fei(Department of Orthopaedics,Center of Orthopaedic Surgery,First Affiliated Hospital,Army Medical University (Third Military Medical University),Chongqing,400038,China)

机构地区：[1]陆军军医大学(第三军医大学)第一附属医院骨科全军矫形外科中心,重庆400038

出　　处：《第三军医大学学报》2019年第9期877-884,共8页Journal of Third Military Medical University

基　　金：西南医院临床医学创新基金(SWH2013LC23)~~

摘　　要：目的评价新型同种异体骨椎间融合器治疗颈椎病的安全性和有效性,观察融合器下沉对术后功能改善的影响。方法回顾性分析我院2015年1月至2016年12月采用BioCage~?融合器和PEEK融合器行单节段前路颈椎间盘摘除、椎间融合术(anterior cervical discectomy and fusion,ACDF)的颈椎病患者80例,通过颈椎正侧位X线片及CT评估颈椎曲度、椎间高度、融合器位置和融合情况。使用VAS和NDI评分评估临床症状的改善情况。观察新型同种异体骨椎间融合器的临床应用效果。结果 43例单节段颈椎病患者采用BioCage~?融合器行ACDF手术,男性29例,女性14例,平均年龄50. 44(24～81)岁; 37例患者采用PEEK融合器行ACDF手术,男性26例,女性11例,平均年龄49. 31(24～78)岁;随访时间12～36(平均23. 02)个月。Biocage组和PEEK组随访中颈椎曲度较术前明显改善(P <0. 05),椎间高度末次随访时虽有丢失,但仍较术前明显恢复(P <0. 05)。随访时患者VAS和NDI评分明显低于术前(P <0. 05)。术后即刻与术后1年融合器后缘到椎体后壁距离(D-PCW)比较差异无统计学意义(P> 0. 05)。术后两组融合器下沉高度及下沉发生率差异均无统计学意义(P> 0.05)。术后3个月,根据CT判断BioCage~?组全部融合,融合率为100%(43/43); PEEK组有1例未融合,融合率为97. 30%(36/37)。术后6个月两组均全部融合。本组患者中共有17例术后出现融合器下沉,其中BioCage~?组9例,PEEK组8例,VAS及NDI评分分别降低3. 94(5. 09～1. 15)、26. 87(35. 34～8. 47),与未下沉患者VAS及NDI评分比较差异均无统计学意义(P> 0. 05)。结论新型同种异体骨椎间融合器按国人颈椎解剖外形设计,终板骨性接触面积大,表面齿状突起可有效防止融合器的滑移,提供术后即刻稳定性,有利于恢复颈椎正常生理前凸,治疗单节段颈椎病具有较好的安全性和有效性。Objective To evaluate the efficacy and reliability of a novel allograft cervical cage in treatment of cervical spondylosis,and observe the effect of subsidence on clinical outcome.Methods We retrospectively reviewed 80 cases with cervical spondylosis undergoing anterior cervical discectomy and fusion(ACDF)with BioCage■or PEEK cage in our department from January 2015 to December 2016.During follow-up,X-ray film(anterior-posterior and lateral)and computed tomography(CT)scan were used to assess segmental and overall cervical lordosis,intervertebral height,cage positioning,and final fusion state.Visual analog scale(VAS)and neck disability index(NDI)were calculated to evaluate clinical outcomes.Results There were 43 cases(29 males and 14 females,at a mean age of 50.44 years,ranging from 24 to 81)undergoing ACDF using Biocage■and 37 cases(26 males and 11 females,at a mean age of 49.31 years,ranging from 24 to 78)using PEEK cage.During the follow-up of 12 to 36 months(average 23.02 months),the segmental and overall cervical lordosis were greatly improved in both groups(P<0.05),and the intervertebral height was also significantly better than that of pre-operation(P<0.05)though having some loss in the last follow-up.The VAS score and NDI score were obviously reduced after operation(P<0.05).No migration or extrusion of the cage(by the distance from posterior edge of fusion cage to posterior vertebral body wall,D-PCW)was observed immediately after surgery and at the latest follow-up.There were no statistical differences in the height and occurrence of subsidence between the 2 kinds of fusion cages.In 3 months postoperatively,BioCage■group all achieved bone fusion according to the CT image,with a fusion rate of 100%(43/43),while 1 case of PEEK group had not gotten fusion,with a fusion rate of 97.3%(36/37),and this case achieved fusion in 6 months postoperatively.Among the 17 cases experiencing cage subsidence,9 were from the BioCage■group and 8 from the PEEK group.In these subsidence cases,their VAS and NDI scores we

关 键 词：颈前路减压植骨融合术 同种异体骨 椎间融合器 聚醚醚酮 脊柱融合 下沉 

分 类 号：R197.39[医药卫生—卫生事业管理] R681.55[医药卫生—公共卫生与预防医学]