3D打印ACT钛金骨小梁椎间融合器行颈椎前路减压融合后颈椎的矢状位平衡变化  

Changes in cervical sagittal balance after three-dimensional printing ACT titanium cage in anterior cervical discectomy with fusion

作　　者：杨旭 赵晓峰[1] 齐德泰 王晓楠 靳元璋 周润田 赵斌[1] Yang Xu;Zhao Xiaofeng;Qi Detai;Wang Xiaonan;Jin Yuanzhang;Zhou Runtian;Zhao Bin(Department of Orthopedics,Second Hospital of Shanxi Medical University,Taiyuan 030001,Shanxi Province,China)

机构地区：[1]山西医科大学第二医院骨科,山西省太原市030001

出　　处：《中国组织工程研究》2020年第36期5741-5748,共8页Chinese Journal of Tissue Engineering Research

摘　　要：背景:颈前路椎间盘切除减压融合是目前临床上常用的手术入路,但对于其植入物的选择,临床上存在较大争议。3D打印钛金骨小梁材料具有优越的生物学特性,十分适合作为骨植入物材料。目的:观察应用3D打印ACT钛金骨小梁椎间融合器行颈前路减压融合患者术后临床疗效及矢状位影像学参数的变化。方法:回顾性分析行单节段颈前路椎间盘切除减压融合的颈椎病患者60例,根据融合器类型分组,对照组30例应用聚醚醚酮融合器,试验组30例应用3D打印ACT钛金骨小梁椎间融合器。记录手术时间、术中出血量以及术中C臂透视次数,临床评价指标记录日本骨科协会评分、疼痛目测类比评分及颈椎功能障碍指数;测量术前、术后3d、术后3个月及末次随访时颈椎侧位X射线的矢状面参数,包括手术节段椎间隙高度、椎间隙角度、C2-7 Cobb角、C2-7矢状位轴向距离及T1倾斜角;根据美国FDA和Kandziora标准判断椎间融合器的融合率;分析患者各时间点影像学参数间的相关性采用Pearson相关性分析。结果与结论:①术后随访15-49个月;②试验组的手术时间、术中出血量及术中C臂透视次数均小于对照组,末次随访时2组日本骨科协会评分均较术前显著增加,疼痛目测类比评分及颈椎功能障碍指数评分显著减少(P <0.05),2组之间差异无显著性意义;③2组手术节段椎间隙高度、椎间隙角度、C2-7 Cobb角及T1倾斜角在术后3 d、3个月及末次随访时较术前均有增加(P <0.05);术后3个月及末次随访时,试验组手术节段椎间隙高度、C2-7 Cobb角、椎间隙角度及T1倾斜角均高于对照组(P <0.05);④C2-7 Cobb角与椎间隙角度及T1倾斜角,椎间隙角度与T1倾斜角,T1倾斜角与C2-7矢状面轴向距离在各时间点均呈正相关(P <0.01),而C2-7矢状面轴向距离与C2-7 Cobb角呈负相关(P <0.01);⑤故应用3D打印ACT钛金骨小梁椎间融合器及聚醚醚酮融合�BACKGROUND:Anterior cervical discectomy with fusion is a commonly used surgical approach in clinical practice.However,there is a great controversy on the choice of implants.Three-dimensional printing titanium trabecula material has superior biological characteristics and is very suitable for bone implants.OBJECTIVE:To investigate changes of radiographic parameters in sagittal plane and clinical scores using three-dimensional printing ACT titanium cage in anterior cervical discectomy with fusion.METHODS:A retrospective analysis was conducted in 60 single-segment cervical spondylosis patients undergoing anterior cervical discectomy with fusion.All patients were grouped according to fusion type.The 30 patients in the control group used poly-ether-ether-ketone fusion cage.The 30 patients in the trial group used three-dimensional printing ACT titanium cage.Operation time,intraoperative blood loss,intraoperative C-arm fluoroscopy,Japanese Orthopaedic Association scores,visual analogue scale score for pain as well as neck disability index were recorded.The sagittal parameters of the cervical standing radiographs were measured at pre-operation,3 days,3 months after operation and the last follow-up,including height of operation segment,angle of operation segment,C2-7 Cobb angle,C2-7 sagittal vertical axis and T1 slope.The fusion rate of the interbody fusion cage was judged according to the US FDA and Kandziora standards.The correlation among these imaging parameters at various time points was analyzed using Pearson correlation analysis.RESULTS AND CONCLUSION:(1)All cases were followed up for 15 to 49 months.(2)Operation time was shorter,intraoperative blood loss,the number of intraoperative C-arm fluoroscopy were less in the trial group than in the control group.At the last follow-up,the Japanese Orthopaedic Association score increased significantly compared with preoperatively,the visual analogue scale and the neck disability index scores decreased significantly(P<0.05);there was no significant difference between the two

关 键 词：骨 钛 骨小梁 椎间融合器 3D打印 颈椎病 融合 矢状面 颈椎曲度 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学]