3D打印多孔钛合金骨小梁融合器与自体髂骨治疗脊髓型颈椎病  

3D printed porous titanium alloy fusion cage and autologous iliac bone in the treatment of cervical spondylotic myelopathy

作　　者：姬林松 王艳萍 陆廷盛 贾祎佳 罗春山 Ji Linsong;Wang Yanping;Lu tingsheng;Jia Yijia;Luo Chunshan(Department of Spine Surgery,Guizhou Orthopedic Hospital,Guiyang 550002,Guizhou Province,China;Department of Gastroenterology,Guizhou Orthopedic Hospital,Guiyang 550002,Guizhou Province,China)

机构地区：[1]贵州省骨科医院脊柱外科,贵州省贵阳市550002 [2]贵州省骨科医院消化内科,贵州省贵阳市550002

出　　处：《中国组织工程研究》2022年第18期2817-2822,共6页Chinese Journal of Tissue Engineering Research

基　　金：2019年度贵阳市科学技术局、贵州省骨科医院大健康科技合作项目(筑科[2019]9-5-4),项目负责人:姬林松。

摘　　要：背景:颈椎前路融合手术最常用的植骨材料是自体髂骨,但是并发症的发生率较高。近年来3D打印融合器因为具有接触面积大、良好的力学性能及生物相容性、弹性模量近似于椎体等优点,已成为颈前路手术较理想的植骨材料。目的:比较3D打印多孔钛合金骨小梁融合器和自体髂骨治疗脊髓型颈椎病的疗效差异。方法:纳入贵州省骨科医院2011年1月至2020年1月收治的脊髓型颈椎病患者65例,男38例,女27例,其中28例行颈前路椎间盘切除减压、3D打印多孔钛合金骨小梁融合器置入与钛合金板内固定治疗(试验组),37例行颈前路椎间盘切除减压、自体髂骨植入与钛合金板内固定治疗(对照组)。术后1,3,6,12个月时,进行日本骨科协会(JOA)评分、融合节段高度及融合节段Cobb角评估。结果与结论:①两组患者均完成术后12个月随访,切口均Ⅰ期愈合,试验组、对照组术后出现喉部疼痛、吞咽困难症状分别为3,2例,未出现钢板断裂、融合器退出及沉降等内固定并发症,对照组中有3例出现植骨块沉降;②65例患者术后6-9个月内完成骨性融合,术后相同时间点下,两组间JOA评分、融合节段高度、融合节段Cobb角比较差异均无显著性意义(P>0.05);③结果表明,颈前路椎间融合治疗脊髓型颈椎病中,采用3D打印融合器及自体髂骨植骨均可获得良好的效果。BACKGROUND:The most commonly used bone graft material for anterior cervical fusion surgery is autologous iliac bone,but the incidence of complications is high.In recent years,3D printed fusion cages have become an ideal bone graft material for anterior cervical surgery because of their large contact area,good mechanical properties and biocompatibility,and elastic modulus similar to that of a vertebral body.OBJECTIVE:To compare the effect of 3D printed porous titanium trabecular bone fusion cage and autologous iliac bone in treating cervical spondylotic myelopathy.METHODS:From January 2011 to January 2020,sixty-five patients with cervical spondylotic myelopathy(38 males and 27 females)underwent anterior decompression and fusion in the Guizhou Orthopedic Hospital.Twenty-eight cases were treated with 3D printing titanium trabecular fusion and plate internal fixation(trial group).Another 37 cases were treated with autogenous iliac bone graft and internal fixation(control group).At 1,3,6,and 12 months after surgery,the Japanese Orthopaedic Association(JOA)score,the height of the fusion segment,and the Cobb angle of the fusion segment were evaluated.RESULTS AND CONCLUSION:(1)After 12-month follow-up,the incisions in the two groups of patients healed in the first intention.There were three and two cases of throat pain and dysphagia in the trial group and the control group after surgery,respectively.There were no internal fixation complications such as plate breakage,cage withdrawal,or subsidence.In the control group,three cases affected bone graft subsidence.(2)All 65 cases completed bony fusion within 6-9 months.There was no significant difference in JOA score,intervertebral height,and segment Cobb angle between the two groups(P>0.05).(3)It is concluded that during anterior cervical interbody fusion for the treatment of cervical spondylotic myelopathy,3D printed fusion cages and autogenous iliac bone grafts have achieved good results.

关 键 词：颈椎病 钛合金骨小梁 自体髂骨 植骨融合 颈前路减压融合 椎间隙高度 颈椎曲度 

分 类 号：R459.9[医药卫生—治疗学] R687.1[医药卫生—临床医学]