钛网并前路钢板在颈前路手术中的应用

目的探讨钛质外科网及带锁钢板在颈椎病损手术治疗中的应用价值。方法对48例颈前路减压术临床资料进行回顾性研究,按JOA评分评定手术效果,颈椎正侧位及屈伸位X线检查判断融合效果。结果JOA评分从术前11.08分±1.68分提高到术后13.56分±1.65分,无一例患者症状加重;按照上海长征医院CSM标准评定,优良率达87.5%。椎体间隙高度得以恢复,植入物无移位脱落,钛钢板及螺钉无移位及松动,植骨融合良好。结论钛质外科网包容自体椎体骨颗粒行植骨融合结合前路钢板固定术可代替自体髂骨融合术,治疗效果肯定,可缩短手术时间,避免取髂骨所致并发症。     

脊髓型及神经根型颈椎病的前路手术治疗

[目的]观察颈椎前路减压融合内固定术治疗脊髓型及神经根型颈椎病的临床疗效.[方法]2005年8月～2010年2月,158例脊髓型及神经根型颈椎病患者实施颈椎前路椎间隙减压自体髂骨植骨、椎体次全切减压钛网植入及椎间隙Cage植入钢板内固定术,158例患者全部获得随访,随访时间平均11.3个月.[结果]采用JOA评分评定临床效果,JOA评分13～16分,平均13.6分,其中优135例,良23例.植骨在3～6个月内融合,无骨不连及假关节形成.全组病例无1例神经症状加重、高热、应急性溃疡等并发症.[结论]颈椎前路减压融合内固定术治疗脊髓型及神经根型颈椎病的临床疗效满意,是较好的手术方式.甲基强的松龙在压迫较重的颈椎病前路手术中能够很好地保护脊髓功能.     

颈椎前路椎体次全切与后纵韧带切除治疗脊髓型颈椎病

目的观察颈椎前路椎体次全切与后纵韧带切除,同时植骨钛板内固定治疗脊髓型颈椎病的疗效。方法治疗脊髓型颈椎病78例,其中相邻两节段者46例,相邻三节段者32例。行单椎体次全切与后纵韧带切除,同时植髂骨或钛网植骨钛板固定46例;两椎体次全切与后纵韧带切除同时植髂骨或钛网植骨钛板固定32例。结果随访6~48个月,根据JOA评分标准,改善率为73%,优良率为85%,有效率为95%。结论椎体次全切与后纵韧带切除,同时植骨内固定术治疗脊髓型颈椎病术中减压安全有效,减压彻底,术后对椎间隙高度的维持可靠。     

颈前路减压自体髂骨植骨钛板内固定治疗脊髓型颈椎病分析

[目的]探讨前路减压植骨钛板内固定术治疗脊髓型颈椎病的疗效.[方法]本科自2000年11月～2010年5月收治27例该类患者,男19例,女8例;年龄40 ～71岁,平均57.5岁,均行颈椎前路减压植骨融合自锁钛板内固定术治疗.[结果]所有患者随访12个月～8年,神经功能明显改善,JOA评分由术前平均8.0分,术后平均改善为14.3分,椎间隙植骨全部融合,无断钉、断板和内固定松动.[结论]经颈前路椎管减压自体髂骨植骨融合自锁钛板内固定术是治疗脊髓型颈椎病的有效方法,疗效满意.     

颈椎前路Zephir钢板治疗脊髓型颈椎病临床疗效分析

目的探讨颈椎前路Zephir钢板系统治疗脊髓型颈椎病的临床疗效。方法对43例脊髓型颈椎病患者行颈前路减压、椎体间自体髂骨植骨融合或颈椎椎间融合器（钛网或Cage）融合、Zephir钢板内固定术,术后随访0．5—3年。结果临床结果按JOA颈椎病疗效判定标准评定,优16例,良19例,有效7例,无效1例,恶化0例。优良率为81．39％,平均植骨融合时间为12周,植骨融合率为100％。结论Zephir钢板治疗脊髓型颈椎病安全有效,提高了植骨融合率,临床疗效满意。     

异体腓骨移植在脊髓型颈椎病治疗中的应用

目的　探讨冻干异体腓骨移植替代髂骨进行颈椎前路减压融合治疗颈椎病的可行性。方法　回顾性分析了 38例采用经颈椎前路减压冻干异体腓骨移植融合结合前路钛钢板固定治疗颈椎病的临床效果。平均随访 (9 5± 3 4 )个月 ,按JOA评分及Nurick分级评定手术效果 ,颈椎正、侧位及屈、伸侧位X线检查判定融合效果。　结果　JOA评分从术前的 (12 5 4± 1 6 2 )分提高到 (16 0 7±1 13)分 (P <0 0 5 ) ;Nurick分级从术前的 (2 4 6± 0 4 3)级提高到术后的 (0 72± 0 37)级 (P <0 0 5 )。经X线检查证实椎间隙高度得到恢复、颈椎生理前凸部分恢复、植骨块无移位、脱落、塌陷 ,钛钢板及螺丝钉无移位及松脱。 5个月后植骨全部融合。　结论　在颈椎病前路手术中冻干异体腓骨移植融合结合前路钛钢板固定术可替代自体骨移植融合术。此手术方法短期效果可靠 ,减少了取髂骨的并发症 ,椎间隙及颈椎的生理前凸可以得到恢复     

颈椎病前路减压不同重建术式疗效的临床观察

目的探讨颈椎病前路减压后,应用自体髂骨植骨加前路钢板内固定、钛网植骨加前路钢板内固定、多枚颈椎钛金属Vigor椎间融合器及多枚聚醚醚酮(PEEK)融合器等不同重建方式,在恢复颈椎稳定性,维持颈椎病疗效的应用价值。方法总结2001年-2006年82例脊髓型颈椎病,采取椎体次全切+自体髂骨植骨+Windows钢板内固定术、椎体次全切+钛网植骨+Windows钢板内固定术、多个单间隙减压+颈椎Vigor椎间融合器及多个单间隙减压聚醚醚酮(PEEK)界面固定治疗。结果平均随访1.5年,82例患者颈椎生理前凸及椎间隙高度恢复满意,神经功能得到不同程度恢复。结论颈椎病前路手术后的神经功能恢复与减压的彻底性及脊髓受压变性密切相关,手术应达到充分减压,彻底解除脊髓压迫。应用自体髂骨植骨加前路钢板内固定、钛网植骨加前路钢板内固定、多枚颈椎钛金属Vigor椎间融合器及多枚聚醚醚酮(PEEK)融合器等不同重建方式,能使颈椎即刻稳定,维持颈椎生理曲度及椎间高度,有利于维持颈椎病的远期疗效。     

前路两种不同术式治疗脊髓型颈椎病的疗效分析

目的探讨前路两种不同的减压植骨融合术治疗脊髓型颈椎病的疗效。方法回顾性分析2004年9月-2009年6月治疗的65例脊髓型颈椎病患者。37例采用颈椎前路减压+自体髂骨植骨+锁定钢板内固定术(A组),28例采用颈椎前路减压+钛网融合器+锁定钢板内固定术(B组),术后根据JOA评分及X线表现比较2种方法的疗效。结果 2组患者术后3个月、末次随访时JOA评分与术前比较,差异有显著性(P0.05)。平均椎间高度末次随访时,A组和B组比较差异无显著性(P0.05)。术后6个月植骨全部融合。结论脊髓型颈椎病治疗的关键在于充分减压及有效植骨融合,自体植骨或钛网融合器+锁定钢板固定牢固是治疗脊髓型颈椎病的较好方法 。     

前路钛钢板加钛网植骨内固定治疗多节段脊髓型颈椎病作用评价

目的：探讨前路钛钢板加钛网植骨内固定治疗多节段脊髓型颈椎病的效果及意义，方法：总结1998年至2002年期间收治的25例有2-3个节段突出的脊随型颈椎病行前路椎体次全切术前路钛钢板加钛网植骨内固定术，结果：经平均12个月的随访，25例患者植骨全部融合，无钛网移位脱落，无螺钉松动，钢板断裂，神经功能得到了不同程度恢复。结论：应用前路钛钢板加钛网植骨内固定术治疗有2-3个节段突出的脊髓型颈椎病是安全有效的。     

前路减压植骨融合术治疗多节段脊髓型颈椎病

目的探讨带锁钢板在颈前路减压植骨术治疗多节段脊髓型颈椎病中的价值。方法42例脊髓型颈椎病,全部行颈前路椎体次全切除减压、自体髂骨植骨加带锁钢板固定术。结果植骨全部于术后12~16周骨性愈合。术后恢复之椎间高度未发生再丢失现象,颈椎生理曲度维持良好。术后JOA评分由术前平均8.5分升至14.5分。结论颈前路椎体次全切除减压、自体髂骨植骨加带锁钢板固定术治疗多节段脊髓型颈椎病具有很好的效果。     

Vertebral autograft used as bone transplant for anterior cervical corpectomy: technical note

OBJECTIVE: In this prospective patient study, we used a surgical technique for autograft bone fusion during anterior cervical corpectomy (ACC) in patients experiencing cervical spondylotic myelopathy. We packed the resected bone material of the corpectomy into a titanium mesh cage. To evaluate the efficacy of our autograft technique, we analyzed the results according to neurological outcome, radiological outcome, and complications. METHODS: Between 1995 and 1998, 27 ACC operations were performed for cervical spondylotic myelopathy caused by multisegmental cervical spondylosis. In all patients, decompression of the cervical canal and/or spinal nerve roots was performed by a median cervical corpectomy by an anterior approach. After the ACC was completed, a titanium mesh cage, which was variable in diameter and length, was filled with morselized and impacted bone material from the cervical corpectomy and was then implanted. An anterior cervical plate was placed in all patients to achieve primary stability of the cervical vertebral column. Age, sex, pre- and postoperative myelopathy, number of decompressed levels, radiological results, and complications were assessed. The severity of myelopathy was graded according to the scoring system of the Japanese Orthopaedic Association. RESULTS: Symptomatic improvement of neurological deficits was achieved in 80% of the patients. The mean preoperative Japanese Orthopaedic Association score improved from 13.1 to 15.2 postoperatively (P < 0.05). No patient demonstrated worsening of myelopathic symptoms. Radiological follow-up studies demonstrated complete bony fusion in all patients. A vertical movement of 2.25 +/- 0.43 mm of the titanium cage into the adjacent vertebral bodies was observed in 24 patients. In patients with either a lordotic or neutral cervical spinal axis postoperatively, the axis remained unchanged during the entire follow-up period. CONCLUSION: The results of this study demonstrate that transplantation of autograft bone material harvested during the ACC integrated well in the cage and in the adjacent vertebral bodies. Thus, complications associated with explantation of autograft material from other donor sites, e.g., the iliac crest, could be avoided. The early postoperative and midterm follow-up periods provided no evidence of morphological or functional instability of the operated cervical segments when this autograft technique was used in combination with cervical instrumentation.     

Anterior cervical reconstruction using titanium cages with anterior plating.

STUDY DESIGN: A preliminary outcome assessment study of titanium cage implants with anterior cervical plating in anterior cervical reconstruction. OBJECTIVES: To evaluate the efficacy and safety of using titanium cage implants and anterior plating in cervical reconstruction. SUMMARY OF BACKGROUND DATA: Anterior decompression and interbody fusion is a widely accepted surgical treatment for patients with cervical spondylosis. Tricortical iliac crest autograft has been the gold standard but is associated with morbidity at the bone graft donor site, whereas allograft fibula is associated with pseudarthrosis. Problems such as pseudarthrosis, graft collapse, and extrusion still persist with the accepted method of harvesting and implanting bone autografts. METHODS: Thirty-four patients were treated by channel corpectomy followed by placement of a titanium cage packed with autogenous bone graft from the vertebral bodies to reconstruct the anterior column. An anterior cervical plate was added in 30 of 34 cases that involved decompression of two or more levels. The follow-up period ranged from 24 to 56 months, with an average follow-up period of 32 months, and included examination and radiography. RESULTS: Six months after surgery, there was radiographic evidence of fusion in 97% of the patients. Eighty-eight percent of the patients (30 of 34) did not experience any complications (neither cage dislodgment nor hardware failure). Four patients had complications that included pseudarthrosis (1), extruded cage (1), cage in kyphosis (1), and radiculopathy (1). CONCLUSIONS: Titanium cages provide immediate strong anterior column support with minimum hardware complications and avoid bone graft-site morbidity. Titanium cages, with concomitant use of anterior plating, offer an effective and safe alternative to bone autografts.     

Pitfalls of anterior cervical fusion using titanium mesh and local autograft

Cervical fusion cages have been developed to provide an anterior structural support without harvesting tricortical iliac bone. Limited numbers of investigations have focused on pitfalls of anterior cervical fusion using cage implants. The objective of this study is to report clinical results and implant-related complications in anterior cervical fusion using titanium mesh and anterior plating. Twenty-four cases with anterior cervical fusion using a titanium mesh with local autograft and anterior plating were reviewed. One-level fusion was performed in 7 cases, and 17 patients underwent two-level fusion with corpectomy. The mean follow-up period was 27 months. Radiographic assessment included sagittal alignment, fusion status, and complications related to cage implants. Iliac bone graft harvesting was obviated in all the patients, whereas 15 patients required concomitant use of ceramic bone substitute. Sagittal alignment of the operative level was lordotic in 19 cases (79%) and neutral in 5 cases (21%) at the final follow-up. No late kyphotic collapse was observed. Twenty-three cases (96%) achieved a solid fusion, whereas the time to fusion was averaged 6.2 months. Cage subsidence frequently occurred in 42% of upper vertebrae and 50% of lower vertebrae. The use of titanium mesh and local autograft for anterior cervical fusion obviated the need for harvesting iliac bone block and provided structural anterior column support. However, it required a longer period to achieve a solid fusion when compared with tricortical iliac autograft. Cage subsidence was frequently observed in the early postoperative period.     

颈前路椎体次全切钛网植骨钛网裁切技术探讨

目的探讨颈椎前路椎体次全切除减压钛网植骨钢板内固定患者术中钛网修剪的技巧以获得更好的接触面.方法47例脊髓型颈椎病患者,病变累及单间隙7例,双间隙40例,行前路椎体次全切除减压钛网植骨并辅以O-rion钢板内固定.术中根据钛网结构和所需长度进行设计,采用四种不同的方法进行剪切.结果47例中43例获6～18月随访,植骨均在12周达到临床愈合,未见钛网下沉、颈椎椎间高度及曲度改变.结论通过针对不同长度的特殊设计和钛网剪切,增加钛网接触面积,可以减少因接触面原因导致的钛网下沉.     

Implantation of a distractible titanium cage after cervical corpectomy: technical experience in 20 consecutive cases

BACKGROUND: This prospective observational study was undertaken to investigate the advantages, the safety, and the drawbacks of reconstructing a cervical corpectomy with a distractible corpectomy cage. According to the author's literature search, this is the second clinical report on a distractible cervical corpectomy cage. METHOD: 20 Consecutive patients underwent a single- or multi-level cervical corpectomy for spondylotic myelopathy, traumatic fracture, or tumor. The corpectomy defect was reconstructed by means of a distractible titanium cage, and local bone from the corpectomy was layed around the cage for fusion. An anterior cervical plate and/or a posterior lateral mass or pedicle screw fixation was added in all patients. The average follow-up was 14 months, and all patients had at least 12 months of follow-up. FINDINGS: No hardware failure occurred in any of the patients. Construct stability was achieved in 19 out of 20 patients (95%) at 12 months postoperatively. The mean regional lordosis was 1 degrees preoperatively, 9 degrees postoperatively, and 7 degrees at the follow-up. Mean neck pain on a VAS was 3.9 preoperatively, and 2.6 at 12 months. There were three perioperative complications: transient neurological worsening in one patient, one transient vocal cord paralysis, and persistent dysphagia in one patient. CONCLUSION: A single- or multi-level cervical corpectomy can be safely and effectively reconstructed by a distractible titanium cage and local bone graft in combination with anterior cervical plating and/or posterior lateral mass/pedicle screw fixation. Potential advantages of this technique are an unforced cage insertion in its non-distracted position, press-fitting the cage into the corpectomy defect through cage distraction, correction of kyphosis or preservation of local lordosis through cage distraction, and the absence of donor site morbidity. However, the stability rate in the current series did not exceed the fusion rates of auto- or allografts.     

多节段颈椎间盘突出症的术式选择

[目的]探讨多节段颈椎间盘突出术式选择的基本原则和方法。[方法]根据每个病人影像学改变的特点分别采用前路开槽减压,植骨钛板内固定;钛网 钛板固定;主要节段钛网 钛板,次要节段环锯减压 Cage融合固定;以及前后路联合手术等多种方法进行治疗。经术后观察随访,对其取得的疗效进行分析总结。[结果]采用不同的方法对96例不同类型的颈椎病进行手术治疗,经过平均2年8个月的随访,效果满意,优良率达到90%。[结论]对多节段颈椎间盘突出或椎间盘退变的脊髓型颈椎病,根据病人不同的影像学改变和症状体征选择不同的手术方式。其关键是要分清主要节段、次要节段,广泛或局限,有无明显的发育性狭窄等不同情况,选择不同的治疗方法。多数病人均能通过颈前路的开槽减压内固定而取得满意效果。单节段椎间退变选择椎间隙减压植骨固定;2~3节段椎间退变一般选择开槽减压内固定;广泛性退变或椎管明显狭窄,连续型颈椎后纵韧带骨化等病例应结合后路减压扩大椎管才能达到有效治疗。手术方法的选择是取得颈椎病良好疗效的关键。     

Long-term biomechanical stability and clinical improvement after extended multilevel corpectomy and circumferential reconstruction of the cervical spine using titanium mesh cages

STUDY DESIGN: Retrospective review of clinical case series. OBJECTIVE: We present our experience with extended (> or =3 levels) anterior cervical corpectomy (EACC) and reconstruction. SUMMARY OF BACKGROUND DATA: Multilevel cervical corpectomy has traditionally been associated with increased graft-related complications and worse clinical outcomes compared with single-level procedures. Data specifically regarding corpectomies across 3 or more levels remains limited. METHODS: Retrospective review of data on 20 patients who underwent anterior cervical corpectomies with titanium mesh cage reconstruction and supplemental posterolateral fixation across 3 or more levels of the cervical spine. Anteroposterior/lateral plain films were used to determine sagittal balance and cage subsidence. Fusion was defined as the lack of motion on flexion-extension radiographs. Patients underwent preoperative and postoperative clinical assessment using visual analog scores and Nurick grading. RESULTS: Surgery was performed for spondylotic myelopathy in 15 patients, osteomyelitis in 4, and fracture in 1. Corpectomies were performed across an average of 3.4 levels. Average follow-up was 33 months. Local autograft was used in all cases except osteomyelitis, where allograft was used instead. Sagittal balance was improved or maintained in all patients and was not related to number of corpectomy levels. An average of 30.2 degrees of kyphosis correction was achieved in 9 patients. All patients demonstrated radiographic evidence of fusion without significant cage subsidence and no cases of instrumentation failure. Improvement in pain and functional scores occurred in all cases. CONCLUSIONS: Circumferential reconstruction using titanium mesh cages after EACC can provide appropriate, biomechanically stable fixation and allows for significant correction of preexisting kyphosis. Supplemental posterior instrumentation may limit delayed cage subsidence and loss of sagittal balance after this procedure. EACC and circumferential reconstruction seems to be an effective treatment for symptomatic degenerative, traumatic, or infectious pathology involving 3 or more levels of the anterior cervical spine.     

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。     

Implantation of a distractible titanium cage after cervical corpectomy: technical experience in 20 consecutive cases

Summary Background. This prospective observational study was undertaken to investigate the advantages, the safety, and the drawbacks of reconstructing a cervical corpectomy with a distractible corpectomy cage. According to the author’s literature search, this is the second clinical report on a distractible cervical corpectomy cage. Method. 20 consecutive patients underwent a single- or multi-level cervical corpectomy for spondylotic myelopathy, traumatic fracture, or tumor. The corpectomy defect was reconstructed by means of a distractible titanium cage, and local bone from the corpectomy was layed around the cage for fusion. An anterior cervical plate and/or a posterior lateral mass or pedicle screw fixation was added in all patients. The average follow-up was 14 months, and all patients had at least 12 months of follow-up. Findings. No hardware failure occurred in any of the patients. Construct stability was achieved in 19 out of 20 patients (95%) at 12 months postoperatively. The mean regional lordosis was 1° preoperatively, 9° postoperatively, and 7° at the follow-up. Mean neck pain on a VAS was 3.9 preoperatively, and 2.6 at 12 months. There were three perioperative complications: transient neurological worsening in one patient, one transient vocal cord paralysis, and persistent dysphagia in one patient. Conclusion. A single- or multi-level cervical corpectomy can be safely and effectively reconstructed by a distractible titanium cage and local bone graft in combination with anterior cervical plating and/or posterior lateral mass/pedicle screw fixation. Potential advantages of this technique are an unforced cage insertion in its non-distracted position, press-fitting the cage into the corpectomy defect through cage distraction, correction of kyphosis or preservation of local lordosis through cage distraction, and the absence of donor site morbidity. However, the stability rate in the current series did not exceed the fusion rates of auto- or allografts.     

颈椎椎体次全切除钛网钢板固定治疗颈椎管狭窄症

目的探讨颈椎椎体次全切除钛网钢板固定治疗颈椎管狭窄症的疗效。方法对确诊为颈椎管狭窄症患者62例,采用颈前路椎体次全切除钛网植骨钢板固定,对比手术前后患者的JOA评分,分析术前、术后及随访时的动力位片,观察钛网、钢板的位置及颈椎前凸角的变化。结果获得完整随访的患者42例,术后随访6～48个月（平均24个月）,6～8个月均获得植骨融合。术后颈椎前凸角改善明显,钛网及钢板位置稳定,JOA评分在术后获得较显著提高（P〈0.05）。结论颈椎椎体次全切除钛网钢板固定治疗颈椎管狭窄症近期疗效肯定,是一种值得推广的术式,但该术式应严格掌握其适应证。