前路颈椎间盘切除3D打印微孔钛合金椎间融合器与聚醚醚酮椎间融合器椎间融合术治疗脊髓型颈椎病的疗效对比  

Comparison of the efficacy of ACDF in the treatment of cervical spondylotic myelopathy using 3D printed intervertebral fusion cage and Polyether-ether-ketone(PEEK) intervertebral fusion cage

作　　者：李玉伟[1] 王海蛟[1] 崔巍[1] 李程 周鹏[1] 效伟 温艳[1] 胡冰涛 李凡 赵世新 LI Yuwei;WANG Haijiao;CUI Wei(Department of Orthopedics,Luohe central hospital,Luohe,He'nan,462000,China)

机构地区：[1]漯河市中心医院骨科,河南省漯河市462000

出　　处：《中国脊柱脊髓杂志》2021年第1期16-24,共9页Chinese Journal of Spine and Spinal Cord

摘　　要：目的 :比较前路颈椎间盘切除后应用3D打印微孔钛合金椎间融合器或聚醚醚酮(PEEK)椎间融合器行椎间融合术治疗脊髓型颈椎病(CSM)的疗效。方法:2017年5月~2019年3月我院收治的需行前路颈椎间盘切除椎间融合术的CSM患者71例,按照随机数字表法将患者随机分为观察组(行颈前路椎间盘切除减压、3D打印微孔钛合金椎间融合器置入内固定术,35例)和对照组(行颈前路椎间盘切除减压、PEEK椎间融合器置入内固定术,36例)。观察组男性26例、女性9例,年龄46.4±4.9岁,病程2.5±0.2年,单节段病变19例、双节段病变16例。对照组男性23例、女性13例,年龄46.1±4.3岁,病程2.5±0.2年,单节段病变20例,双节段病变16例。两组患者术前资料无统计学差异(P>0.05)。在术前、术后3个月及末次随访时,对患者进行JOA评分及颈椎正侧位、过伸过屈位X线片检查,在X线片上测量融合节段的椎体高度及Cobb角并观察植骨融合情况。比较两组患者在术前、术后3个月及末次随访时的JOA评分及改善率、融合节段的椎体高度变化及Cobb角变化、植骨融合情况。结果:患者手术顺利,术后出现颈部吞咽不适症状8例(观察组3例,对照组5例),1~2周后上述症状消失。两组均无钢板螺钉断裂、移位发生,12个月随访时均骨性融合。观察组手术时间94.6±18.0min、术中出血量117.8±41.9ml、住院时间10.0±2.2d,对照组手术时间89.2±18.5min、术中出血量127.5±39.0ml、住院时间10.3±2.5d,两组手术时间、术中出血量、住院时间的对比差异均无统计学意义(P>0.05)。观察组JOA评分由术前9.3±1.7分提高至术后12个月时的14.5±1.6分,改善率为(67.5±4.7)%,对照组JOA评分由术前的8.2±2.8分提高至术后12个月时的13.3±1.5分,改善率为(58.1±4.1)%。两组改善率比较差异无统计学意义(t=1.292,P=0.200)。观察组单节段(19例)融合节段椎体高度术前为31.21±0.94mm、术后3个月时�Objectives: To compare the efficacy of 3D-printed interbody fusion cage and PEEK cage in the treatment of cervical spondylotic myelopathy(CSM). Methods: From May 2017 to March 2019, 71 patients suffered from CSM were randomly divided into observation group(35 with anterior cervical discectomy and interbody fusion with 3D-printed intervertebral cage) and the control group(36 with anterior cervical discectomy interbody fusion with PEEK cage). There were 26 males and 9 females in the observation group, with an average age of 46.4±4.9 years and a course of disease of 2.49±0.24 years. There were 23 males and 13 females in the control, with an average age of 46.1±4.3 years and a course of disease of 2.53±0.21 years. There was no statistically significant difference in preoperative data between the two groups(P>0.05). All of them completed the operation successfully, and the follow-up time was 12-23 months. 8 patients(3 in the observation group and 5 in the control) showed dysphagia after the operation, however, the symptoms disappeared after 1-2 weeks. JOA score and X-ray were performed before surgery, 3 months postoperatively, and at the final follow-up. The vertebral body height and Cobb Angle of the fusion segment were measured on the X-ray to observe the bone graft fusion. T-test, χ2 test and ANOVA were used for comparison between the two groups, P<0.05 was considered statistically significant. Results: No plate and screw fracture or displacement occurred in both groups, and bone healing was observed at 12 months of follow-up. There were no statistically significant differences between the observation group and control group in operation time(94.6±18.0 min vs 89.2±18.5 min),intraoperative blood loss(117.8±41.9 ml vs 127.5±39.0 ml), and hospital stay(10.0±2.2 d vs 10.3±2.5 d), respectively(P>0.05). At final follow-up, the JOA score of the observation group was increased from 9.3±1.7 preoperatively to 14.5±1.6 after 12 months, with the improvement rate of 67.5%, while that in the control was increased fr

关 键 词：脊髓型颈椎病 椎间融合器 聚醚醚酮 3D打印 

分 类 号：R687.3[医药卫生—骨科学]