单节段颈椎前路减压融合手术不同内固定方式对邻近节段退行性变影响的影像学对比研究  

Comparative effect of different internal fixation methods on degeneration of adjacent segments in single segment cervical anterior decompression and fusion surgery

作　　者：朱斌[1] 荆珏华[1] 周云[1] 田大胜[1] 陈磊[1] ZHU Bin;JING Jue-hua;ZHOU Yun;TIAN Da-sheng;CHEN Lei(Department of Orthopedics,the Second Affiliated Hospital of Anhui Medicne School,Hefei 230601,Anhui,China)

机构地区：[1]安徽医科大学第二附属医院骨科,安徽合肥230601

出　　处：《生物医学工程与临床》2020年第5期533-538,共6页Biomedical Engineering and Clinical Medicine

摘　　要：目的观察单节段颈椎前路减压融合术后不同内固定融合手术方式对邻近节段退行性变的影像学影响,探讨颈椎前路融合术中的手术创伤操作相关因素对相邻节段退行性变的影响。方法选择2016年1月至2019年5月于安徽医科大学第二附属医院脊柱外科行颈椎前路单节段融合术治疗颈椎退行性疾病患者29例,其中男性14例,女性15例;年龄32~64岁,平均年龄50.4岁;病程4个月~42个月,平均病程36.6个月。其中钛板内固定组15例;C-jaws组14例;所有病例均行单节段融合,其中C3/41例,C4/52例,C5/622例,C6/74例;对比术前和术后影像学上邻近节段变化情况。在颈椎X射线上测量前路内固定上下缘与邻近椎体终板切线之间的距离,即钛板或C-jaws与上下椎间隙的距离;对比手术前后邻近节段椎间隙高度变化和邻近节段骨赘变化;在颈椎MRI T2加权成像上评估邻近节段椎间盘退行性变分级程度。统计并分析随访两组不同内固定融合方式邻近节段退行性变的发生率。结果研究组随访6~36个月,平均随访28.6个月。术后钛板、C-jaws上缘与邻近间隙距离分别为(1.63±0.45)mm、(4.25±0.56)mm,差异有显著统计学意义(P <0.001);钛板、C-jaws下缘与邻近间隙距离分别为(2.85±0.48)mm、(5.75±0.36)mm,差异有显著统计学意义(P <0.001);X射线片随访中54个相邻节段中8个相邻间隙出现不程度的退行性变。按照邻近节段退行性变影像诊断标准,颈椎前路融合术后邻近节段退行性变的发生率为14.8%(8/54),其中钛板内固定组发生率为22.2%(6/27),C-jaws组发生率为7.4%(2/27),差异有显著统计学意义(P <0.001);20例患者获MRI随访,末次随访时,40个相邻节段中14个相邻间隙出现不程度的退行性变,邻近节段退行性变的发生率为35.0%(14/40),其中钛板内固定组发生率为45.0%(9/20),C-jaws组发生率为25.0%(5/20),差异有显著统计学意义(P <0.001)。结论对于颈椎前路手术患者,�Objective To observe effects of different internal fixation fusion methods on adjacent segmental degeneration after anterior cervical decompression and fusion by imaging, and probe effects of operative trauma related factors on adjacent segmental degeneration during anterior cervical fusion. Methods From January 2016 to May 2019, 29 patients with cervical degenerative diseases underwent anterior cervical single-segment fusion were enrolled, which included 14 males and 15 females,aged 32-64 years old with mean age of 50.4 years old. The disease course was 4-month to 42-month with mean course of 36.6-month. Titanium plate internal fixation in 15 cases and C-jaws fixation in 14 cases. The single-segmental fusion was performed in all cases, including 1 case of C3/4, 2 cases of C4/5, 22 cases of C5/6 and 4 cases of C6/7. The changes of adjacent segments in preoperative and postoperative imaging were compared. The distance between upper and lower margin of anterior internal fixation and the tangent line of adjacent endplate was measured on X-ray of cervical spine, which was the distance between titanium plate or C-jaws and upper and lower intervertebral. The height of intervertebral of adjacent segments and osteophytes of adjacent segments before and after surgery were compared. The grade of intervertebral disc degeneration in adjacent segments was evaluated on MRI T2-weighted images of cervical spine. The incidence of adjacent segment degeneration with different fusion methods was analyzed. Results The study group was followed-up for 6-36 months with mean followed-up of 28.6 months. The distance between upper margin and adjacent titanium plate or C-jaws after surgery was(1.63 ± 0.45) mm and(4.25 ± 0.56) mm, respectively, and the difference was significant between 2 groups(P < 0.001). The lower margin and adjacent distances of titanium plate and C-jaws were(2.85 ± 0.48) mm and(5.75 ± 0.36) mm, respectively, and the difference was significant between 2 groups(P < 0.001). In X-ray followed-up, 8 of 54 adjacent segmen

关 键 词：颈椎前路融合 钛板 C-jaws 邻近节段 颈椎 退行性变 

分 类 号：R681.5[医药卫生—骨科学] R318.01[医药卫生—外科学]