3D打印微孔钛合金融合器用于颈椎前路减压植骨融合对颈椎解剖学及应激激素的影响  

Efficacy of 3D printed microporous titanium fusion device applied to anterior cervical decompression graft fusion and its effects on cervical spine anatomy and stress hormones

作　　者：蒋成明 蒋赛男 唐烨 蒋林 Jiang Chengming;Jiang Sainan;Tang Ye;Jiang Lin(Department of Spine Surgery,The First Hospital of Changsha,Changsha 410005,Hunan Province,China;Department of Science and Education,The First Hospital of Changsha,Changsha 410005,Hunan Province,China)

机构地区：[1]长沙市第一医院脊柱外科,湖南省长沙市410005 [2]长沙市第一医院科教科,湖南省长沙市410005

出　　处：《中国组织工程研究》2023年第18期2837-2841,共5页Chinese Journal of Tissue Engineering Research

基　　金：吴阶平医学基金会一般项目(320-2745-16-178),项目负责人:蒋林。

摘　　要：背景:3D打印微孔钛合金融合器具备与松质骨、椎体皮质骨较为接近的弹性模量,进一步分析其临床应用效果,对颈椎手术中融合器的合理选择具有重要的指导意义。目的:探讨3D打印微孔钛合金融合器在颈椎前路减压植骨融合中的应用效果,以及其对患者颈椎解剖学、应激激素的影响。方法:选择2016年3月至2021年9月长沙市第一医院收治的脊髓型颈椎病患者90例,男46例,女44例,年龄(46.85±9.74)岁,采用随机数字表法分为2组,对照组(n=45)颈椎前路减压植骨融合术中置入聚醚醚酮椎间融合器与自体骨,观察组(n=45)颈椎前路减压植骨融合术中置入3D打印微孔钛合金融合器。术后1周,采用日本骨科协会脊髓功能量表评价疗效;术后3d及3个月,拍摄颈椎X射线片记录颈部解剖学指标;术后1,3 d,采集静脉血检测去甲肾上腺素、皮质醇水平;术后3个月,采用颈部失能指数、日常生活能力量表评价患者肢体功能状态。结果与结论:(1)两组临床疗效优良率比较差异无显著性义(P>0.05);(2)观察组术后3个月的颈椎融合节段高度、融合节段Cobb角、T1倾斜角均高于对照组(P<0.001),术后1,3 d的皮质醇、去甲肾上腺素水平均低于对照组(P<0.001);(3)观察组术后3个月的颈部失能指数低于对照组(P<0.001),日常生活能力量表评分高于对照组(P<0.001);(4)结果表明,3D打印微孔钛合金融合器应用于颈椎前路减压植骨融合中可取得良好的效果,能减轻机体应激、改善肢体功能,同时在保持颈椎解剖形态方面具有优势。BACKGROUND:3D printed intervertebral fusion has elastic modulus closer to cancellous bone and vertebral cortical bone,and further analysis of the effect of its clinical application is an important guideline for the reasonable selection of fusion device for cervical spine surgery.OBJECTIVE:To investigate the effectiveness of 3D printed microporous titanium fusion in anterior cervical decompression graft fusion and its effects on cervical spine anatomy and stress hormones.METHODS:Totally 90 patients with cervical spondylotic myelopathy in The First Hospital of Changsha from March 2016 to September 2021 were selected,including 46 males and 44 females,aged(46.85±9.74)years old.They were divided into two groups by the random number table method.Patients in the control group(n=45)received anterior cervical decompression graft fusion with a polyetheretherketone interbody fusion and autogenous bone.Patients in the observation group(n=45)received anterior cervical decompression graft fusion with a 3 D printed microporous titanium fusion.One week after the operation,the Japanese Orthopaedic Association Spinal Cord Function Scale was used to evaluate the curative effect.At 3 days and 3 months after the operation,cervical spine X-ray films were taken to record the anatomical indexes of the neck.At 1 and 3 days after operation,venous blood was collected to detect the levels of norepinephrine and cortisol.At 3 months after the operation,the neck disability index and the daily living ability scale were used to evaluate the limb function status of the patients.RESULTS AND CONCLUSION:(1)There was no significant difference in the excellent and good rate of clinical efficacy between the two groups(P>0.05).(2)The height of the fused segment,Cobb angle of the fused segment,and T1 tilt angle of the observation group were higher than those of the control group at 3 months after surgery(P<0.001).The cortisol and norepinephrine levels of the observation group were lower than those of the control group at 1 and 3 days after surgery(P<0.0

关 键 词：3D打印 微孔钛合金融合器 聚醚醚酮椎间融合器 脊髓型颈椎病 颈椎前路减压植骨融合 应激激素 生物相容性 

分 类 号：R459.9[医药卫生—治疗学] R319[医药卫生—临床医学] R687