颈椎前路不同融合方式维持椎间高度的对照研究

目的 比较颈椎前路自体植骨、环锯减压加椎间融合器（cage）以及自体植骨加钢板内固定对术后椎间高度的维持效果。方法 对1998年3月至2004年6月收治的117例接受颈椎前路融合术的颈椎病患者进行回顾性分析。其中男65例,女52例;年龄31-72岁,平均57岁。117例患者中1个椎间隙受压91例,2个椎间隙受压26例。行单纯自体三面皮质髂骨植骨31例（单纯植骨组）;环锯减压加cage自体植骨38例（cage融合组）;自体三面皮质髂骨加自锁钢板固定48例（钢板内固定组）。融合节段高度测量采用融合节段上下终板中部高度。脊髓功能采用JOA评分方法。统计学方法采用单因素方差分析。结果 所有患者均获得随访,随访时间13～59个月,平均23个月。至最后随访时,单纯植骨组椎间高度平均丢失1.94mm,明显高于cage融合组1．48mm和钢板内固定组1．25mm,差异有统计学意义（P〈0．05）。术后1年,各组脊髓功能恢复均满意,差异无统计学意义。钢板内固定组有3例出现内固定失败,再手术后恢复满意。无其他严重并发症发生。结论颈椎前路融合术中,合理选用cage或钢板内固定可有效维持术后椎间高度。     

颈椎前路减压不同融合方式椎间隙高度丢失分析

目的　探讨颈椎前路减压植骨融合术后椎间隙高度丢失的预防方法。方法　对随访资料完整的前路减压植骨融合术并获得骨性融合的 6 9例患者进行回顾分析。平均随访 7 8个月 ,于术后 1周、3～ 6个月摄颈椎侧位X线片 ,以同片相邻节段的高度为参照 ,测量手术植骨节段椎间隙术前术后高度。结果　 2 0例椎间隙高度丢失 <2mm ,4 9例椎间隙高度的丢失 2～ 8mm。结论　颈椎前路植骨融合术后椎间隙高度丢失的原因是多方面的 ,其中主要和手术植骨的方法、患者骨质疏松程度有关。减压后采用自体髂骨植入、颈椎钢板内固定的手术方式 ,其椎间隙高度丢失最少     

颈椎前路钛网钢板内固定及自体髂骨植骨在不同颈椎节段中的生物力学研究

目的 采用颈椎前路钛网钢板及自体髂骨植骨对不同颈椎节段进行内固定，分析其生物力学改变。方法 取自愿捐赠的6具新鲜尸体C3～7标本，C5、C5.6及C4～6椎体次全切除后，分别行髂骨植骨和钛网前路钢板内固定术，测量各节段的前屈、后伸、左、右侧弯及左、右旋转运动变化，以完整标本作为对照组。结果 自体髂骨的植入使失稳颈椎的稳定性提高，其侧弯、屈伸运动度减少，与对照组比较，差异有统计学意义（P〈0．05），但抗旋转运动减少不明显（P〉0．05）。不同颈椎节段开槽减压椎间撑开钛网前路钢板内固定状态下，手术节段的即刻稳定性比对照组及撑开植骨状态增加（P〈0．05）。结论 颈椎前路椎体次全切除之后，植骨仅能部分改善其稳定性，但应用颈椎前路钛网钢板内固定可明显增强颈椎的稳定性，也较完整颈椎运动功能单位稳定。     

颈前路多节段减压重建术后生理弧度的前瞻性研究

目的：研究颈椎前路多节段减压后不同手术方法对颈椎结构的远期影响。方法：采用前瞻性研究,选取４９例随机分为２ 组。对照组在牵伸状态下植入３ 面皮质骨;试验组在用颈椎撑开器牵开椎间隙,植入自体骨后用前路钢板内固定。测量手术节段椎间高度及生理弧度。结果：Ｘ 线测量显示,试验组术后１ 周生理弧度明显增加,１ 月后生理弧度继续增加;其椎间高度较术前增加６ ｍ ｍ 以上,随访１ 年内椎间高度无明显改变。对照组术后１ 周生理弧度也有增加,但增加值明显低于试验组;术后１ ～３ 月生理弧度逐渐回复至术前水平。结论：颈椎前路牵开植骨加钢板内固定能有效地增加并维持颈椎椎间隙高度。     

不同术式治疗单间隙脊髓型颈椎病的疗效比较

目的:比较单纯环锯减压柱状植骨与椎体次全切除块状植骨加内固定治疗单间隙脊髓型颈椎病的效果。方法:对91例单间隙脊髓型颈椎病患者分别采用单纯前路环锯减压柱状双面皮质骨植骨术(45例)及椎体次全切除减压块状双面皮质骨植骨加内固定术(46例)治疗,术后根据JOA评分及X线表现比较两组病例的改善率、植骨融合率及融合节段高度丢失情况。结果:平均随访15个月,环钻减压组平均改善率为45%,优良率64%,3例并发颈脊髓损伤致瘫痪;椎体次全切除组平均改善率为72%,优良率86%,无脊髓损伤等严重并发症。两组植骨融合率均为100%。环锯减压组术后融合节段高度的丢失(平均2.1mm)明显大于椎体次全切除组(平均0.71mm)(P<0.05)。结论:椎体次全切除植骨加内固定术术中减压更为安全有效,术后对椎间隙高度的维持更为可靠,疗效优于单纯环锯减压植骨术。双面皮质骨植骨可获得满意的融合率。     

颈椎椎体间融合器在脊髓型颈椎病治疗中的应用

目的 观察颈椎椎体间融合器(cervical interbody fusion cage,CIFC)在脊髓型颈椎病前路手术中的应用疗效,并与环锯法颈椎前路减压植骨融合术(环锯法)作对比分析。方法 CIFC组42例,共56个椎间隙,环锯法组40例,共50个椎间隙,术后定期随访及拍摄X线片,观察疗效及手术融合节段的稳定性、椎间高度和融合情况。结果 CIFC组56个椎间隙中52个间隙获得骨性融合,融合率92.86％,术后2周椎间高度较术前增加(1.5±0.8)mm,随访24个月,椎体高度仍较术前增加(1.1±0.6)mm,生理曲度维持满意,无内植物并发症;环锯法组50个椎间隙中有41个间隙获骨性融合,融合率82％,23例26个间隙不同程度的存在椎间高度丢失、椎体塌陷,椎间高度较术前降低(1.2±0.7)mm。结论 应用颈椎椎体间融合器能使颈椎融合节段获得术后即刻稳定,提高椎间骨性融合率和维持术后椎间高度,降低自体植骨并发症,并能维持脊髓减压疗效。     

颈椎前路融合术中植入骨长度对治疗效果的影响

研究颈椎前路融合术中,植入骨长度对减压效果的影响。方法采用前路环锯截骨、长窗减压,在牵引下植入自体长条形髂骨。结果在前路环锯截骨植入自体髓骨手术中,截骨节段在２个或以上的病例,植入植长度和骨槽长度之差作出调整后,治疗效果优于传统的植入骨长度比骨槽长１－２ｍｍ的病例。     

钢板内固定在颈椎前路术中的应用

颈椎骨折、颈椎间盘突出症、颈椎节段性不稳、单节段或多节段脊髓型颈椎病等病症在临床中并不少见。随着MRI的普及和广泛应用,我们发现很多病例的脊髓压迫都来自前方。从治疗角度来说,以往的环锯法减压、单纯开槽式减压在维持减压节段椎节的高度和生理曲度以及颈椎稳定性方面均存在一定缺陷,远期随访效果并不理想。自2000年起,我们采用颈椎前路开槽式减压自体髂骨植骨加自锁钢板内固定治疗颈椎骨折、颈椎间盘突出症、颈椎节段性不稳、单节段或多节段脊髓型颈椎病、颈椎后纵韧带骨化病(OPLL)等病种患者38例,平均随访19个月,效果良好。本手…     

颈椎间不同植入物固定后稳定性的比较

目的：比较颈前路减压后分别植入异体骨螺纹晤支架、肽合金融合支架和自体髂骨对椎间稳定性的影响。方法：用８具人尸体颈椎为空白模型,环锯减压后,分别植入异体骨螺纹融合支架、钛合金螺纹融合支架和自体髂骨,测试以上状态下标本的应变和位移结果：减压后标本较空白对照应变和位移增加,异体现有螺纹融合支架、钛合金螺纹融合支架固定能减少这种增加,而自体髂骨只能减少总体位移增加。结论：Ｃｌｏｗａｒｄ术减压后,颈椎稳定下     

早期前路减压植骨加CSLP系统内固定治疗下颈椎骨折脱位

目的 总结早期前路减压植骨融合加CSLP固定系统治疗下颈椎骨折脱位的经验。方法 下颈椎前路减压后用自体髂骨植入加CSLP内固定。结果 61例患者经8个月－4年随访观察,所有的病例植骨均完全愈合。按Frankel分级,术后神经功能恢复良好。结论 颈椎带锁钢板具有高度的内在稳定性,操作简便、安全、并发症少,生物相容性良好,无磁性等优点。只要患者全身状况允许,一周内行前路减压植骨融合加CSLP系统内固定有利于脊髓生理功能的恢复及保持颈椎稳定性。     

颈椎前路带锁钢板治疗颈椎爆裂骨折的试验及临床研究

目的 评价颈椎前路带锁钢板固定系统(CSLP)治疗颈椎骨折的稳定性及临床有效性.方法 将6具新鲜成人颈椎标本(C2～6)置于脊柱三维测量仪上测定C3～5节段的ROM,制造C4爆裂骨折,测定其三维运动变化后分别进行植骨、植骨+CSLP固定,并重复测量其三维运动.对32例下颈椎骨折行前路减压融合,并以CSLP进行内固定治疗.结果 植骨+CSLP固定后在屈伸、侧弯、旋转方向较损伤后明显下降,与正常值相比,屈伸和侧弯运动均明显减少,但旋转运动减少不明显.术后随访6～48个月,所有骨折均复位,颈椎椎体高度恢复,椎间植骨均融合,钢板位置满意,无螺钉松动或脱出.结论 AO前路钢板固定颈椎爆裂骨折时各个运动方向均能获得稳定,临床效果满意,是一种治疗颈椎骨折的理想固定装置.     

颈前路减压支撑融合钢板内固定术治疗脊髓型颈椎病

目的 探讨颈前路减压、椎体间植骨支撑融合或颈椎椎间融合器（钛网或Cage）支撑融合、钢板内固定术治疗脊髓型颈椎病的临床方法及疗效。方法 回顾分析66例脊髓型颈椎病患者行颈前路减压后,分别采取骼骨植骨支撑融合、颈椎间融合器（钛网或Cage）植入支撑融合,钢板内固定术,随访时间平均32个月,采用Zdeblick影像学判定椎体间融合的标准,贾连顺的评定法评定术后临床疗效。结果 在颈前路减压、钢板内固定术治疗脊髓型颈椎病方法中,自体骼骨植骨融合优良率87．5％,供区并发症12．1％,椎间盘退变椎问高度丢失7．6％;颈椎间融合器支撑融合优良率96．1％,无供区并发症和椎问盘退变椎间高度丢失。结论 颈前路减压、椎体间植骨融合或颈椎间融合器支撑融合、钢板内固定术治疗脊髓型颈椎病临床疗效满意。钢板内固定术后颈椎即刻稳定;植骨融合手术操作简单,费用少,但存在供区并发症、椎问高度丢失;椎间融合器融合稳定、牢固,椎间高度丢失少,后者疗效优于前者。     

颈胸段脊柱脊髓伤的诊断及前路手术治疗

目的 探讨颈胸段脊柱脊髓损伤的临床特点、诊断及颈胸段前路减压、植骨、Orion钢板内固定术的治疗作用。方法 分析26例颈胸段脊柱骨折、脱位患者的临床表现;行颈胸段前路C7、T1、C6－7或C7－T1椎体次全切除、植骨及Oron锁定型颈椎前路钢板固定术。结果 颈胸段脊柱脊髓损伤患者通常表现为C8－T1或T2相应节段脊髓神经根症状,10例伴有窦性心动过缓、8例出现低血压、7例出现Horner征等交感节刺激症状。所有患者随访3－20个月,植骨均在3－4个月内完全融合,20例脊髓神经功能有不同程度的改善,上述交感神经节刺激疾病缓解,1术后出现暂时性声音嘶哑。结论 颈胸段脊柱脊髓损伤根据其临床特点、影像学表现可确定诊断;颈胸段前路减压、植骨、Orion钢板内固定术对颈胸段脊柱脊髓损伤具有较好的疗效,Orion钢板有助于植骨节段融合、重建和稳定颈胸段脊柱。     

Kinematics of the cervical spine following discectomy and stabilization

The immediate biomechanical stability of the cervical spine following discectomy and stabilization is described. Fresh human ligamentous spines (C2-T2) were potted, and clinically relevant loads were applied by a loading frame attached to the C2 vertebra of each specimen. A set of three infrared light-emitting diodes (LEDs) were attached rigidly to each of four vertebrae (C4 to C7) to record their spatial locations after each load step application using a Selspot II (Selcom Selective Electronic, Inc., Valdese, North Carolina) system. The specimen was tested in the intact state, following discectomy at the C5-6 intervertebral level, following insertion of a bone graft in the intervertebral space, and following the application of an anterior metal plate. The load-deformation data of the injured and stabilized tests were normalized with regard to the corresponding results of the intact specimens. At the injured level (C5-6), the load-deformation results indicated a highly significant increase in motion in flexion (66.6%), extension (69.5%), lateral bending (41.3%), and axial rotation (37.9%). After the insertion of the bone graft, a significant decrease in motion was seen in the effected segment in extension (-45.9%), with similar reductions in lateral bending and axial rotation and a smaller reduction in flexion. The application of an anterior metal plate in addition to the bone graft at the injured level provided significant reduction in motion (-70%) in all load modalities. This data may have clinical relevance regarding the role of internal fixation in cases of severe spine instability.     

颈椎前路蝶形钢板内固定系统的研制及临床应用

目的研制颈椎前路蝶形钢板内固定系统,评价其生物力学稳定性,并进行临床初步应用观察。方法该系统包括蝶形钢板及三种不同用途的螺钉,采用单皮质螺钉固定及点接触原理,由医用钛合金材料 (TC4)制成。采用 14具青年男性尸体的新鲜颈椎标本,利用脊柱三维运动分析系统,比较蝶形钢板固定与 Orion钢板固定对失稳颈椎的稳定作用。临床上应用于颈椎患者的治疗 61例,其中颈椎病 26例,颈椎间盘突出症 14例,颈椎骨折脱位 18例,颈椎结核 3例。结果生物力学测试表明,该蝶形钢板内固定系统可以提供足够的颈椎稳定性,与 Orion钢板内固定系统的稳定作用相似。临床应用中, 61例患者均行颈前路减压、自体髂骨植骨融合术,并采用蝶形钢板内固定。 48例患者门诊随访 6～ 10个月,植骨块均在术后 3～ 4个月内获得骨性愈合,无钢板断裂,无螺钉松动、断裂、脱落等并发症。结论该颈椎前路蝶形钢板内固定系统具有良好的生物力学稳定性,固定效果佳,操作简便,且适合国人的解剖特点,能满足临床的需要。     

颈椎椎体次全切除钛网钉板系统的临床应用

目的探讨颈椎前路椎体次全切除钛网钉板植骨融合的临床效果。方法自2001年3月～2003年3月间应用颈前路椎体次全切除钛网植骨融合及钉板固定治疗颈椎管狭窄性疾病22例，其中4例患者行2椎体次全切除3节椎间隙减压手术。术后观察减压、固定、融合及神经功能恢复情况，并行X线摄片或CT扫描检查。结果患者获6～12个月随访，神经功能得到不同程度改善，无加重情况。椎间隙高度无丢失、无成角，均获得骨性融合。术后3d在颈围领固定下下床活动，4周后可恢复较轻工作。结论此术式可避免传统手术方法的缺点，即不取自体髂骨，融合率高，稳定性好，并减压彻底，疗效好，是一种值得推广的新技术。     

Biomechanical evaluation of cervical spine fixation after healing in a destabilized cervical spine model in sheep: a comparison of the anterior plating and posterior wiring techniques

BACKGROUND: We conducted biomechanical evaluation of the anterior plating and posterior wiring techniques for cervical spine stabilization after a course of healing in sheep. METHODS: Seventeen sheep were included, and six of which underwent sham operations (group A, n=6). The other eleven received complete C2-C3 destabilization, followed by intervertebral bone grafting and cervical stabilization either with anterior plating (group B, n=5) or posterior wiring (group C, n=6) techniques. These animals were killed 6 months later. Ligamentous spines (C1-C5) were subjected to the relevantly applied loads. The load-deformation data of the C2-C3 and C3-C4 functional units were recorded and analyzed. RESULTS: At the C2-C3 functional unit, group B had the least motion ranges in flexion, lateral bending, and rotation loads than did the other two groups. Significantly smaller motion ranges of lateral bending and rotation loads were found in group B than in group C (p<0.05). Compared with group A, group C had a decreased motion range in flexion load but showed increased motion range in rotation load. Consequently, group B had superior intervertebral fusion and less osteophyte than did group C. At the C3-C4 functional unit, group B showed significantly decreased motion ranges in extension and lateral bending loads (p<0.05), while group C did not. CONCLUSION: The results indicated that the anterior plate-stabilized spines were more stable over time than did the posterior-wired spines. This biomechanical advantage eventually resulted in superior intervertebral fusion masses in the former, although it also induced a slightly decreased motion range at the contiguous functional unit. In exclusively posterior wired-spines, the weakness for opposing rotation loads might contribute to the formation of osteophytes at the fusion functional unit. These data point out that the mode and stability of implant fixation systems greatly influence the biomechanical redistribution and bone-adaptive remodeling process during healing, which are closely related to the bone graft maturation and osteophytic formations at the fusion level and the occurrence of stiffening problems at the contiguous levels.     

颈椎前路减压植骨钛板内固定治疗颈脊髓损伤

目的评价颈椎前路减压植骨内固定治疗颈椎骨折合并颈脊髓损伤的临床疗效。方法对215例颈椎骨折合并颈脊髓损伤的患者施行颈椎前路减压、自体髂骨植骨和颈椎带锁钛板内固定术。术后定期复查X线片,判定脊髓功能恢复情况。结果随访184例患者,平均随访时间3．5年。术后3个月植骨块获得骨性愈合,颈椎椎间高度和生理曲度维持满意,无内置物并发症,172例患者神经功能提高1～2级,仅12例A级患者神经功能无恢复。结论颈椎骨折合并颈脊髓损伤应尽早行前路减压、植骨、钛板内固定术,有利于脊髓功能恢复,能使损伤节段获得即刻、坚强的稳定,方便护理和功能锻炼。     

颈椎带锁钢板在急性颈椎间盘突出症中的应用

目的：探讨颈椎带锁钢板在急性颈椎间盘突出症的应用价值。方法：20例急性颈椎间盘突出症患者施行颈前路减压、自体髋骨植骨及颈椎带锁钢板内固定术。结果：20例均获得随访6-24个月，平均随访时间13个月。所有病例植骨完全愈合，无一例发生钢板螺钉松动、断裂等并发症，结论：颈椎前路带锁钢板应用于急性颈椎间盘突出症可显著提高植骨融合率，并可提供有效的固定节段稳定性。     

Biomechanical stability of lower cervical spine immediately after discectomy with grafting

Objective: Anterior cervical discectomy is commonly used to treat radiculopathy and myelopathy. Although the size of the implanted graft may influence the clinical outcome of anterior reconstruction of the cervical spine, the ideal graft height remains arguable. The objective of the current study was to study the interrelations of graft height and immediate biomechanical stability in an anterior cervical discectomy model. Methods: Six fresh‐frozen human cadaver cervical spines (C1–T1) were tested in five sequential states. The first state tested was the “normal” state (specimens with intact discs). The other four states were tested after C5–C6 discectomy by the Smith‐Robinson graft technique, using graft thicknesses of 100%, 120%, 140%, and 160% of the baseline height. The baseline height was defined as the intervertebral disc height of C5–C6 at the intact stage. Intervertebral segment flexion, extension, bending and rotation of C5–C6 were recorded using a 3D laser scanner and analyzed using Geomagic Studio 5.0 software. Results: Bone grafting at 100% baseline height after discectomy provided the least stability and the greatest movement range. With increasing height of grafts, the movement range of the cervical spine declined. Immediate stability of the operated segments was significantly increased by grafting with 140% and 160% baseline heights compared to the baseline height condition. Conclusions: Strut‐graft with appropriate distraction after Smith‐Robinson anterior cervical discectomy plays an important role in the whole immediate biomechanical stability of the lower cervical spine. A graft height of 40% greater than baseline may be ideal after single discectomy in clinical practice.