前路颈椎单椎体次全切除术中采用髂骨块植骨/Cage填充自体碎骨植骨治疗脊髓型颈椎病

目的　比较前路颈椎单椎体次全切除术中采用髂骨块植骨/Cage填充自体碎骨植骨治疗脊髓型颈椎病(CSM)的中期临床疗效。方法 2000年3月—2004年12月采用单椎体次全切除术并自体髂骨块植骨治疗CSM患者21例(A组),2013年1月—2015年12月采用颈椎前路单椎体次全切除术并Cage填充自体碎骨植骨治疗CSM患者32例(B组),对2组患者临床资料进行回顾性分析,对比颈椎整体曲度、融合节段角度、融合节段椎体间高度、融合率、沉降率及颈椎日本骨科学会(JOA)评分等指标。结果术后3 d及末次随访时2组颈椎整体曲度、融合节段角度及融合节段椎体间高度与术前相比均显著改善,差异有统计学意义(P 0.05),组间比较差异无统计学意义(P 0.05)。A组1例发生植骨未融合,B组无植骨未融合发生。术后3个月及末次随访时2组JOA评分与术前相比均显著改善,差异有统计学意义(P 0.05),组间比较差异无统计学意义(P 0.05)。末次随访时B组沉降率(34.3%)高于A组(23.8%),差异有统计学意义(P 0.05)。2组末次随访时发生沉降者JOA评分与未发生沉降者相比,差异无统计学意义(P 0.05),并未影响远期临床疗效。结论前路颈椎单椎体次全切除术治疗CSM,与采用传统髂骨块植骨融合相比,术中采用Cage填充自体碎骨植骨可获得相近的影像学及临床疗效,Cage沉降并未显著影响远期疗效。

Treatment of cervical spondylotic myelopathy with iliac bone grafting/Cage-filled autologous bone grafting in anterior cervical single segment corpectomy

Objective To compare the mid-term clinical effect of iliac bone grafting and Cage-filled autologous bone grafting in anterior cervical single segment corpectomy for cervical spondylotic myelopathy(CSM). Methods From March 2000 to December 2004,21 CSM patients were treated with anterior cervical single segment corpectomy and autogenous iliac bone grafting(group A),and from January 2013 to December 2015,32 CSM patients were treated with anterior cervical single segment corpectomy and Cage-filled autologous bone grafting(group B). The data of 2 groups were analyzed retrospectively. The overall cervical curvature,angle of fusion segment,height of fusion segment,fusion rate,sedimentation rate and Japanese Orthopaedic Association(JOA) score of the cervical spine were analyzed and compared. Results The overall cervical curvature,angle of fusion segment and height of fusion segment of the 2 groups on postoperative 3 d and the final follow-up were significantly improved compared with those before the operation,with statistical significances(P<0.05),but there was no significant difference between the 2 groups(P>0.05). In group A,1 patient did not get fused,while all the patients got fused in group B. The JOA scores of the 2 groups in postoperative 3 months and the final follow-up were significantly improved compared with those before the operation,with statistical significances(P<0.05),but there was no significant difference between the 2 groups(P>0.05). At the final follow-up,the sedimentation rate of group B(34.3%) was higher than that of group A(23.8%),with a statistical significance(P<0.05). There was no significant difference in JOA score between patients with and without sedimentation at the final follow-up(P>0.05),which did not affect the long-term clinical efficacy. Conclusion The Cage-filled autologous bone grafting in anterior cervical single segment corpectomy for CSM can provide equal radiography and clinical outcome compared with the traditional iliac bone fusion,and the Cage subsidence phenomenon doesn''t affect the clinical outcome.