颈前路减压cage融合术与自体髂骨块植骨钛板内固定术治疗脊髓型颈椎病的中期疗效

目的:观察颈椎前路减压cage植骨融合术与颈椎前路减压自体髂骨块植骨融合钛板内固定术治疗脊髓型颈椎病的中期临床疗效。方法:2001年1月～2006年4月128例脊髓型颈椎病患者按照手术方式分为A、B两组,A组61例患者采用前路减压单纯PEEK cage植骨融合术治疗,其中病变节段与手术节段均为单节段22例,双节段39例;B组67例采用颈椎前路减压自体髂骨块植骨融合钛板内固定术,其中单节段27例,双节段40例。观察手术前后JOA评分、椎间高度和颈椎曲度情况。结果:A组手术时间为58.1±1.4min,术中出血量为42.4±2.0ml,B组分别为72.0±5.3min、82.7±3.9ml,两组比较差异有统计学意义(P<0.05)。A组23例(39.3%)出现一过性咽部不适,1例硬脊膜破裂,2例cage塌陷、移位;B组49例(73.1%)出现一过性咽部不适,1例硬脊膜破裂,5例髂骨供区痛,2例钉板松动。每组患者术后JOA评分、椎间高度和颈椎曲度均较术前明显改善(P<0.05),A、B组术后JOA评分改善率分别为(82.30±6.61)%和(83.80±4.42)%,组间比较差异无统计学意义(P>0.05)。随访24～60个月,平均36个月,末次随访时A、B组椎间融合率分别为95.2%和96.3%,两组比较差异无统计学意义(P>0.05);末次随访时每组JOA评分、椎间高度和颈椎曲度与术后比较差异无统计学意义(P>0.05)。术前、术后和末次随访时JOA评分、椎间高度和颈椎曲度两组比较差异无统计学意义(P>0.05)。结论:颈椎前路减压cage植骨融合术与颈椎前路减压自体髂骨块植骨融合钛板内固定术治疗脊髓型颈椎病的中期疗效均较好,但前者手术方法简单、近期并发症少。     

前路减压联合钛网及自锁定椎间融合器治疗多节段脊髓型颈椎病

【摘要】 目的：评价前路减压、钛网及自锁定融合器联合重建治疗多节段脊髓型颈椎病的临床疗效及安全性。方法：回顾性分析2012年1月～2014年8月我院行前路减压、钛网与自锁定融合器联合重建治疗的多节段脊髓型颈椎病患者,共32例。其中男17例,女15例。年龄53～74岁,平均65.7±4.2岁。患者影像学上均表现为连续3个节段及以上的脊髓受压,且保守治疗无效。所有患者均为脊髓型颈椎病患者,其中11例患者合并神经根型颈椎病。采用JOA评分及Odom标准评价神经功能及临床效果。观察并记录手术的并发症、融合率、融合器下沉及手术后颈椎生理曲度的变化。结果：手术均顺利完成,钛网及融合器置入成功。平均手术时间113.0±12.5min;术中平均失血量123.0±9.4ml。平均随访时间23.2±2.3个月（12～41个月）。末次随访时JOA评分及颈椎生理曲度均较术前明显增加,并有统计学意义（P＜0.05）。32例患者均获得融合,平均融合时间6.4±0.7个月。无内固定失败,无浅表及深部感染。术后并发症包括脑脊液漏1例（3.1%）,经保守治疗7d后治愈。钛网沉降2例（6.2%）,患者无临床症状;自锁定融合器无沉降。无吞咽困难及声音嘶哑。根据Odom标准,术后疗效优11例,良好17例,一般4例。结论：前路减压、钛网及自锁定融合器联合重建治疗多节段脊髓型颈椎病,安全有效,能够有效恢复颈椎曲度,减少长钛板相关并发症,并获得满意临床结果。     

Relevance of expandable titanium cage for the treatment of cervical spondylotic myelopathy

Background

In patients with cervical spondylotic myelopathy, ventral disease and loss of physiological cervical lordosis are indications for anterior approach. As bone graft and titanium cage present many drawbacks, expandable titanium cage has been recently introduced for this indication. The authors present the clinical and radiological outcomes in patients undergoing the placement of an expandable cage in the treatment of spondylotic myelopathy with straight or kyphotic cervical spine alignment.

Methods

This was a retrospective review of prospectively collected data. A total of 26 patients underwent cervical corpectomy and reconstruction using an expandable titanium cage and anterior plate between 2005 and 2008. Pain and functional disability were measured using VAS and mJOA preoperatively and at 3 months, 6 months, 1 year and 2 years. Kyphosis was measured using lateral radiographs at the same points of follow-up. Fusion was evaluated on flexion–extension radiographs at 2 years.

Results

The mean VAS improved from 4.2 to 1.7 and the mean mJOA increased from 12.85 to 16.04 at 2 years postoperatively (p < 0.05). The mean kyphosis angle decreased from 17° to 2° at the last follow-up (p < 0.05). The fusion rate was 100 % at 2 years. Three complications were reported including a transient dysphagia, an epidural hematoma and an early hardware migration.

Conclusion

Expandable titanium cage is an effective device, which achieves good clinical and radiological outcomes at a minimum 2-year follow-up.     

颈椎前路手术应用端盖钛网治疗合并骨质疏松的老年脊髓型颈椎病对照研究

目的:比较颈前路椎体次全切除应用端盖钛网与无端盖钛网植骨融合术治疗合并骨质疏松的老年脊髓型颈椎病的影像结果及临床疗效。方法:对2011年1月至2016年1月采用颈前路单个椎体次全切除钛网植骨融合术治疗的60例合并骨质疏松老年脊髓型颈椎病患者进行回顾性分析,其中男26例,女34例,年龄68~79岁,平均75.8岁。根据术中所用钛网分为端盖钛网组(A组,32例)及无端盖钛网组(B组,28例)。通过JOA评分对两组患者的神经功能进行评定;通过X线对融合节段椎间高度及前凸角度(Cobb角)进行测量;通过CT评估钛网植骨融合率。结果:60例患者均获随访,随访时间1~2年,平均1.5年。临床疗效评价结果:A组术前JOA评分为9.3±1.7,术后1周、3个月、1年JOA评分分别为14.2±1.8、15.7±1.2、15.4±1.5;B组术前JOA评分为9.1±1.8,术后1周、3个月、1年JOA评分分别为14.5±1.3、14.9±1.7、15.2±1.6。两组术后JOA评分与术前相比均明显改善(P0.05)。术后1周、3个月、1年两组JOA评分比较差异均无统计学意义(P0.05)。影像学评价结果:A组术前融合节段椎间高度为(42.1±2.4)mm,术后1周、3个月、1年分别为(45.3±3.2)mm、(44.7±2.9)mm、(44.5±3.0)mm;A组术前Cobb角为(5.3±1.2)°,术后1周、3个月、1年分别为(10.3±1.9)°、(10.1±1.7)°、(9.9±1.3)°;B组术前椎间高度为(43.4±2.3)mm,术后1周、3个月、1年分别为(45.7±2.8)mm、(44.2±2.7)mm、(41.5±2.1)mm;B组术前Cobb角为(5.4±1.0)°,术后1周、3个月、1年分别为(11.2±1.8)°、(10.8±1.6)°、(7.2±1.4)°。两组术后融合节段椎间高度、融合节段Cobb角与术前比较明显提高(P0.05)。术后1周、3个月A组椎间高度、融合节段Cobb角与B组比较差异无统计学意义(P0.05),术后1年椎间高度、融合节段Cobb角A组均明显优于B组(P0.05),末次随访,A组钛网沉陷率为6%,B组为18%。结论:颈前路手术应用端盖钛网治疗合并骨质疏松的老年脊髓型颈椎病患者,术后维持椎间隙高度及融合节段前凸角度方面优于无端盖钛网,端盖钛网的应用可有效降低骨质疏松患者的钛网沉陷的发生率。     

Efficacy of multilevel anterior cervical discectomy and fusion versus corpectomy and fusion for multilevel cervical spondylotic myelopathy: a minimum 5-year follow-up study

Purpose

We evaluated radiologic and clinical outcomes to compare the efficacy of anterior cervical discectomy and fusion (ACDF) and anterior corpectomy and fusion (ACCF) for multilevel cervical spondylotic myelopathy (CSM).

Methods

A total of 40 patients who underwent ACDF or ACCF for multilevel CSM were divided into two groups. Group A (n = 25) underwent ACDF and group B (n = 15) ACCF. Clinical outcomes (JOA and VAS scores), perioperative parameters (length of hospital stay, blood loss, operation time), radiological parameters (fusion rate, segmental height, cervical lordosis), and complications were compared.

Results

Both group A and group B demonstrated significant increases in JOA scores and significant decreases in VAS. Patients who underwent ACDF experienced significantly shorter hospital stays (p = 0.031), less blood loss (p = 0.001), and shorter operation times (p = 0.024). Both groups showed significant increases in postoperative cervical lordosis and achieved satisfactory fusion rates (88.0 and 93.3 %, respectively). There were no significant differences in the incidence of complications among the groups.

Conclusions

Both ACDF and ACCF provide satisfactory clinical outcomes and fusion rates for multilevel CSM. However, multilevel ACDF is associated with better radiologic parameters, shorter hospital stays, less blood loss, and shorter operative times.     

保留终板的颈椎融合器在颈椎前路手术中的应用

目的:探讨保留终板的颈椎融合器在颈椎前路手术中的应用价值。方法:对试验组22例颈椎病患者进行颈椎前路减压和保留颈椎终板融合器植入术。对照组26例颈椎病患者进行颈椎前路减压和单纯自体髂骨移植。术后随访X线,观察椎间隙高度的变化,比较神经功能恢复情况。结果:术后随访12～24个月,平均16个月,3个月后的X线检查,试验组手术节段椎间隙高度增加(1.1±0.9)mm,而对照组降低(1.0±0.8)mm(P<0.05),试验组和对照组所有患者X线全获骨性融合;术后神经功能均有明显改善。结论:保留终板的椎间融合器能够有效的恢复椎间隙高度,促进颈椎融合。     

A prospective, randomised controlled trial of femoral ring allograft versus a titanium cage in circumferential lumbar spinal fusion with minimum 2-year clinical results

The literature reports on the safety and efficacy of titanium cages (TCs) with additional posterior fixation for anterior lumbar interbody fusion. However, these papers are limited to prospective cohort studies. The introduction of TCs for spinal fusion has resulted in increased costs, without evidence of superiority over the established practice. There are currently no prospective controlled trials comparing TCs to femoral ring allografts (FRAs) for circumferential fusion in the literature. In this prospective, randomised controlled trial, our objective was to compare the clinical outcome following the use of FRA (current practice) to the use of TC in circumferential lumbar spinal fusion. Full ethical committee approval and institutional research and development departmental approval were obtained. Power calculations estimated a total of 80 patients (40 in each arm) would be required to detect clinically relevant differences in functional outcome. Eighty-three patients were recruited for the study fulfilling strict entry requirements (>6 months chronic discogenic low back pain, failure of conservative treatment, one- or two-level discographically proven discogenic low back pain). The patients completed the Oswestry Disability Index (ODI), Visual Analogue Score (VAS) for back and leg pain and the Short-Form 36 (SF-36) preoperatively and also postoperatively at 6, 12 and 24 months, respectively. The results were available for all the 83 patients with a mean follow-up of 28 months (range 24–75 months). Five patients were excluded on the basis of technical infringements (unable to insert TC in four patients and FRA in one patient due to the narrowing of the disc space). From the remaining 78 patients randomised, 37 received the FRA and 41 received the TC. Posterior stabilisation was achieved with translaminar or pedicle screws. Baseline demographic data (age, sex, smoking history, number of operated levels and preoperative outcome measures) showed no statistical difference between groups (p<0.05) other than for the vitality domain of the SF-36. For patients who received the FRA, mean VAS (back pain) improved by 2.0 points (p<0.01), mean ODI improved by 15 points (p=<0.01) and mean SF-36 scores improved by >11 points in all domains (p<0.03) except that of general health and emotional role. For patients who received the TC, mean VAS improved by 1.1 points (p=0.004), mean ODI improved by 6 points (p=0.01) and SF-36 improved significantly in only two of the eight domains (bodily pain and physical function). Revision procedures and complications were similar in both groups. In conclusion, this prospective, randomised controlled clinical trial shows the use of FRA in circumferential lumbar fusion to be associated with superior clinical outcomes when compared to those observed following the use of TCs. The use of TCs for circumferential lumbar spinal fusion is not justified on the basis of inferior clinical outcome and the tenfold increase in cost.     

Evaluation of a new type of titanium mesh cage versus the traditional titanium mesh cage for single-level, anterior cervical corpectomy and fusion

Study design

A retrospective review of prospectively collected data in an academic institution.

Objective

To evaluate the safety and efficacy of a new type of titanium mesh cage (TMC) in single-level, anterior cervical corpectomy and fusion (ACCF).

Methods

Fifty-eight patients consecutive with cervical spondylotic myelopathy (CSM) from cervical degenerative spondylosis and isolated ossification of the posterior longitudinal ligament were treated with a single-level ACCF using either a new type of TMC (28 patients, group A) or the traditional TMC (30 patients, group B). We evaluated the patients for TMC subsidence, cervical lordosis (C2–C7 Cobb and Cobb of fused segments) and fusion status for a minimum of 30 months postoperatively based on spine radiographs. In addition, neurologic outcomes were evaluated using the Japanese Orthopedic Association (JOA) scores. Neck pain was evaluated using a 10-point visual analog scale (VAS).

Results

The loss of height of the fused segments was less for group A than for group B (0.8 ± 0.3 vs. 2.8 ± 0.4 mm) (p < 0.01); also, there was a lower rate of severe subsidence (≥3 mm) in group A (4 %, 1/28) than in group B (17 %, 5/30) (p < 0.01). There were no differences in the C2–C7 Cobb and Cobb of fused segments between the groups preoperatively or at final follow-up (p > 0.05), but the Cobb of fused segments immediately postoperative were significantly less for group B than for group A (p < 0.01). All patients, however, had successful fusion (100 %, each). Both groups had marked improvement in the JOA score after operation (p < 0.01), with no significant differences in the JOA recovery ratio (p > 0.05). The postoperative VAS neck pain scores for group A were significantly less than that for group B (p < 0.05); severe subsidence was correlated with neck pain.

Conclusions

The new type of TMC provides comparable clinical results and fusion rates with the traditional TMC for patients undergoing single-level corpectomy. The new design TMC decreases postoperative subsidence (compared to the traditional TMC); the unique design of the new type of TMC matches the vertebral endplate morphology which appears to decrease the severity of subsidence-related neck pain in follow-up.     

应用异体骨螺纹融合器行颈椎前路融合的疗效分析

目的:评价应用异体骨螺纹融合器(ATFC)行颈椎前路融合的疗效,观察融合器的转归。方法:20例患者行单间隙前路颈椎间盘切除减压后置入ATFC,并与20例植入自体髂骨(AICA)者对照。根据影像学资料,观察不同时期ATFC在体内的变化,测量椎间高度及节段前凸角改变,判断融合情况,并根据Odom标准评价临床疗效。结果:ATFC组与AICA组各有18例获随访,平均随访时间分别为3.5年与3.4。ATFC年组优良率77.8%,AICA组83.3%。ATFC组不融合率16.7%,AICA组11.1%,两组临床疗效及融合率比较差异无显著性。ATFC在术后2￣4个月破裂;年时大部分未被新生骨替代;年时部分被新生骨替代;年时仍未被完全替代。135ATFC组椎间高度平均丢失2.7mm,AICA组丢失1.4mm。ATFC组节段前凸角平均丢失4.5°AICA组丢失1.7°,。两组椎间高度及节段前凸角丢失比较差异有显著性意义(P<0.05)。结论:ATFC在体内的替代是一缓慢过程,其维持椎间高度及节段前凸能力较自体髂骨差。     

Anterior cervical fusion with interbody cage containing β-tricalcium phosphate augmented with plate fixation: a prospective randomized study with 2-year follow-up

A variety of bone graft substitutes, interbody cages, and anterior plates have been used in cervical interbody fusion, but no controlled study was conducted on the clinical performance of β-tricalcium phosphate (β-TCP) and the effect of supplemented anterior plate fixation. The objective of this prospective, randomized clinical study was to evaluate the effectiveness of implanting interbody fusion cage containing β-TCP for the treatment of cervical radiculopathy and/or myelopathy, and the fusion rates and outcomes in patients with or without randomly assigned plate fixation. Sixty-two patients with cervical radiculopathy and/or myelopathy due to soft disc herniation or spondylosis were treated with one- or two-level discectomy and fusion with interbody cages containing β-TCP. They were randomly assigned to receive supplemented anterior plate (n = 33) or not (n = 29). The patients were followed up for 2 years postoperatively. The radiological and clinical outcomes were assessed during a 2-year follow-up. The results showed that the fusion rate (75.0%) 3 months after surgery in patients treated without anterior cervical plating was significantly lower than that (97.9%) with plate fixation (P < 0.05), but successful bone fusion was achieved in all patients of both groups at 6-month follow-up assessment. Patients treated without anterior plate fixation had 11 of 52 (19.2%) cage subsidence at last follow-up. No difference (P > 0.05) was found regarding improvement in spinal curvature as well as neck and arm pain, and recovery rate of JOA score at all time intervals between the two groups. Based on the findings of this study, interbody fusion cage containing β-TCP following one- or two-level discectomy proved to be an effective treatment for cervical spondylotic radiculopathy and/or myelopathy. Supplemented anterior plate fixation can promote interbody fusion and prevent cage subsidence but do not improve the 2-year outcome when compared with those treated without anterior plate fixation. This study was supported by Shanghai Natural Science Foundation (No. 044119626).     

3种颈前路减压重建术式治疗多节段颈椎病

[目的]比较颈前路减压3种术式治疗多节段颈椎病的临床疗效及影像学变化。[方法]选择52例由同一组医师行颈前路减压术的连续三间隙病变的多节段颈椎病患者，依据手术方式不同分为：第1组：颈前路多椎体次全切除减压＋长钛网植骨融合组（16例）；第2组：多椎间隙减压cage植骨融合组（18例）；第3组：钛网与cage组合使用组（18例）。t检验比较3组之间椎间高度变化、方差分析法比较JOA评分改善率。[结果]3组患者术后随访JOA评分均有不同程度提高，但3组间无明显统计学差异；第1组术后早期椎间高度有丢失趋势（P〈0．05），并有3例明显钛网下沉，2例内植物松动，第2组无松动或下沉病例，第3组有1例钛网下沉。[结论]3种方法均可得到可靠的临床效果，但在术后稳定性及椎间高度维持方面第2、3组较第1组满意。     

3D打印人工椎体与钛笼在颈椎前路椎体次全切除减压植骨融合术中应用的效果比较

目的：评估3D打印人工椎体与传统钛笼在颈椎前路椎体次全切除减压植骨融合术(anterior cervical corpectomy and fusion,ACCF)中应用的临床效果。方法：回顾性分析2017年6月～2020年6月于承德医学院附属医院脊柱外科行单椎体ACCF的50例脊髓型颈椎病患者,其中25例术中应用3D打印人工椎体(观察组),25例术中应用传统钛笼植骨(对照组)。记录两组患者手术时间、术中出血量、C型臂X线机透视次数及随访时间。术前、术后3天、术后3个月及末次随访时在颈椎侧位X线片上测量椎体次全切除节段椎间高度(H1、H2)、C2-7 Cobb角、C2-7矢状面轴向距离(C2-7 sagittal vertical axis,C2-7 SVA)及T1倾斜角,比较两组患者各时间点的影像学参数;应用日本骨科协会(Japanese Orthopaedic Association,JOA)评分评价神经功能,应用疼痛视觉模拟(visual analogue scale,VAS)评分评价颈部疼痛。根据Kandziora标准判断植骨融合情况。结果：所有患者均获得随访,观察组随访时间1...     

A prospective study of anterior cervical spondylodesis in intervertebral disc disorders

Summary In 1977, a prospective study of anterior cervical fusion was started in cases of intervertebral disc disorders with neuropathy and/or myelopathy up to 1986. A total of 193 patients was operated upon, of whom 179 were available for this study, with a mean follow-up time of 10.4 years (6-14 years) and a mean age of 51 years (28–76). There was an extensive record for every patient according to the protocol. The indication for operation was decided upon by an orthopaedic surgeon and a neurologist and was defined as discopathy with progressive neurological disorders, which did not respond to conservative therapy. The wearing of a stiff collar for 6 weeks during which time there was a improvement of the neurological symptoms was a strict precondition for the operation. Up to 5 levels were fused, with a mean of 2.3 levels per patient. During the operation a discography was performed on the symptomatic level(s) and the adjacent levels. All levels with positive discopathy were fused. In this longterm study the overall percentage of excellent and good results was about 82%. The results of fusions involving more than two levels were very encouraging.     

颈椎椎间融合器临床应用的失误及并发症分析

目的：探讨颈椎椎间融合器(cervical fusion cage,CFC)临床应用的失误及并发症产生的原因。方法：随访96例植入CFC的脊髓型颈椎病、急性颈椎间盘突出、外伤性颈椎不稳患者，总结CFC临床应用的失误及并发症，并分析产生的原因。结果：3例CFC的植入位置不当，7例患者产生并发症，包括颈椎的生理前凸减小或变直、CFC旋转、脱位、下沉、不融合。产生失误及并发症的原因有：手术操作不当、CFC自身设计不完善、融合节段过多等。结论：减少失误、降低并发症发生率的对策是严格掌握CFC的适应证、规范手术操作、改进CFC的设计。     

自制颈椎融合器的实验研究

目的　探讨自制颈椎融合器在动物体内的应用 ,为进一步临床应用提供实验依据。方法　应用实验动物山羊 2 0头 ,分为实验组和对照组 ,分别测试抗压缩力、椎间隙高度及组织反应。结果　 (1)抗压缩力 :自制颈椎融合器 (3 5 8.64± 15 .63 )N ,自体骨植入组为 (2 68.82± 11.3 6)N ,差异有显著性 (P <0 .0 5 ) ;(2 )椎间高度 :自制颈椎融合器组为 (12 .0 5± 0 .16)mm ,自体髂骨植入组为 (12 .0 5± 0 .14 )mm ,差异无显著性 (P >0 .0 5 ) ;(3 )自制颈椎融合器有较好的生物相容性。结论　自制颈椎融合器强度大、生物相容性好、稳定性好 ,是一种比较理想的颈椎融合器。     

Surgical treatment of spondylodiscitis in the cervical spine: a minimum 2-year follow-up

Cervical spine spondylodiscitis is a rare, but serious manifestation of spinal infection. We present a retrospective study of 20 consecutive patients between 01/1994 and 12/1999 treated because of cervical spondylodiscitis. Mean age at the time of treatment was 59.7 (range 34–81) years, nine of them female. In all cases, diagnosis had been established with a delay. All patients in this series underwent surgery such as radical debridement, decompression if necessary, autologous bone grafting and instrumentation. Surgery was indicated if a neurological deficit, symptoms of sepsis, epidural abscess formation with consecutive stenosis, instability or severe deformity were present. Postoperative antibiotic therapy was carried out for 8–12 weeks. Follow-up examinations were performed a mean of 37 (range 24–63) months after surgery. Healing of the inflammation was confirmed in all cases by laboratory, clinical and radiological parameters. Spondylodesis was controlled radiologically and could be achieved in all cases. One case showed a 15°kyphotic angle in the proximal adjacent segment. Spontaneous bony bridging of the proximal adjacent segment was observed in one patient. In the other cases the adjacent segments radiologically showed neither fusion nor infection related changes. Preoperative neurological deficits improved in all cases. Residual neurological deficits persisted in three of eight cases. The results indicate that spondylodiscitis in cervical spine should be treated early and aggressive to avoid local and systemic complications.     

A prospective clinical comparison of rectangular titanium cages and iliac crest autografts in anterior cervical discectomy and fusion

The complications of autogenous bone grafting cause spinal surgeons to seek alternative methods for cervical spinal fusion. This prospective study was conducted to evaluate the safety and efficacy of rectangular titanium cages as compared to the widely performed iliac crest autograft fusion. Thirty-six patients with cervical disc disease in whom an anterior cervical approach was indicated for discectomy were included in a prospective controlled study protocol with 1-year follow-up. The first 18 consecutive patients received iliac crest autograft, while the next 18 received rectangular titanium cages. According to Odom's criteria, 15 of 18 (83%) patients in both groups experienced good to excellent functional recovery. According to the patient satisfaction index, 17 of 18 (94%) in both groups were satisfied. There were no significant differences in neck or arm pain. Fusion was present after 1 year in 16 of 18 (89%) patients in the iliac crest autograft group and 15 of 18 (83%) in the rectangular titanium cage group. In the autograft group, one case of pseudarthrosis was present, and marked hip pain was observed in four patients. There were no implant-related complications in the cage group. The authors conclude that titanium cages in anterior cervical discectomy constitute a safe and efficient alternative to iliac crest bone autograft.     

纳米羟基磷灰石/聚酰胺66复合物椎间融合器在山羊颈椎融合中的应用

目的:观察纳米羟基磷灰石/聚酰胺66复合物(n-HA/PA66)椎间融合器在山羊颈椎前路融合中的效果。方法:15只成年雌性山羊随机分成A、B、C组,每组5只,均行经前路C3/4椎间盘切除术,A组椎间置入n-HA/PA66椎间融合器植骨;B组置入钛网植骨;C组采用自体三面皮质髂骨块植骨。分别于术前、术后、术后4周、8周及12周拍X线片观察测量各组手术节段平均椎间高度(disc space height,DSH)、椎间角(intervertebral angle,IVA)及前凸角(lordosis angle,LA);12周时处死动物取颈椎标本进行生物力学测试及组织学检查。结果:术前三组DSH、IVA和LA无显著性差异。术后即刻及术后4周三组间DSH无显著性差异(P0.05);术后8周及12周,A组DSH与B、C组有显著性差异(P0.05);B组和C组差别无显著性(P0.05)。术后即刻及术后4周、8周三组间IVA无显著性差异(P0.05);术后12周,A、B组IVA与C组有显著性差异(P0.05),A组与B组无显著性差异。术后即刻及术后4周、8周三组间LA差异无显著性(P0.05);术后12周,A、B组LA与C组有显著性差异(P0.05),B组与C组无显著性差异。术后12周时,A、B组颈椎标本各向角位移与C组有显著性差异(P0.05);除后伸外A组各向稳定性优于B、C组;平均刚度均强于B、C组;ROM均小于B、C组(P0.05)。A组在植骨区和椎间融合器边缘可见大量成熟的骨小梁组织,材料交界处可见大量纤维骨痂及新生骨形成,骨组织与材料表面已发生嵌合;B组的植骨块与椎体间的新生骨小梁已改建为成熟的骨小梁,部分区域尚可见未完全矿化的类骨质;C组可见较多的纤维骨痂形成,在骨小梁表面有红色的类骨质,部分区域有成熟的骨小梁。结论:n-HA/PA66椎间融合器能有效维持椎间隙高度,促进山羊颈椎前路植骨融合。     

脊髓型颈椎病早期诊断指标的选择及临床意义(84例前瞻性研究报告)

目的：探讨脊髓型颈椎病（ＣＳＭ）早期诊断的可能性，筛选预示ＣＳＭ发作的临床、影像学及电生理指标。方法：根据ＣＳＭ常见特征，选择２９项与ＣＳＭ发病有关的指标并据此建立研究对象的入选标准。对８４例符合预选指标的患者进行２～６５年（平均３７年）的随访追踪观察，并将手术组与非手术组的各项指标做对照研究。结果：２９例演变为ＣＳＭ并行早期手术处理，术后疗效良好。有１３项指标与ＣＳＭ发病密切相关。结论：颈椎病早期诊断是有可能的。凡符合入选标准的患者，有必要密切观察和随访。早期手术有望获得良好疗效     

颈椎前路融合与人工椎间盘置换术联合治疗多节段脊髓型颈椎病

目的:探讨颈椎前路减压后行融合与人工椎间盘置换联合手术治疗多节段脊髓型颈椎病的临床疗效。方法:2008年10月～2009年6月共收治多节段脊髓型颈椎病患者52例,其中24例行颈椎前路减压融合与人工椎间盘置换联合手术(A组),28例采用颈椎前路椎体次全切联合椎间盘切除植骨内固定术(B组)。两组患者分别在术前、术后3d、3个月、12个月、24个月时应用JOA评分评价临床疗效;统计两组的手术时间及出血量;摄颈椎前屈后伸位X线片观察人工椎间盘活动度及颈椎整体活动度;行MRI或CT扫描检查假体位置及异位骨化情况。结果:两组患者术后临床症状缓解,脊髓功能改善,均无严重并发症。JOA评分结果示各组术后各时间点JOA评分较术前明显提高(P<0.01),两组术后各时间点间比较无显著性差异(P>0.05)。与B组比较,A组手术时间短,术中出血量少(P<0.05),置换节段活动度维持良好,颈椎整体活动度恢复较快且较好(P<0.05)。末次随访时,A组人工椎间盘置换节段未发现异位骨化,未见邻近节段退变;B组中2例出现邻近节段退变。结论:与单纯前路融合手术相比,前路融合与人工椎间盘置换联合手术治疗多节段脊髓型颈椎病既能缩短手术时间、减少出血量,又能在达到良好前路减压目的的同时维持手术节段活动度及颈椎整体曲度,减少手术邻近节段代偿活动度的增加,从而预防相邻节段退变的发生。