颈前路钛网植骨融合术后钛网沉陷的原因分析

目的:探讨颈前路钛网植骨融合术后钛网发生沉陷的原因及其对颈椎曲度和临床疗效的影响,并提出相应改善对策。方法:对24例颈前路钛网植骨融合术后钛网发生沉陷的病例行影像学检查,观察骨密度、钛网修剪及放置情况、钢板类型、终板处理情况等,JOA评分法评价手术前后及钛网沉陷后神经功能改变情况,测量手术前后及钛网沉陷后颈椎曲度“D”值并行统计学比较。结果:钛网发生沉陷的原因主要为钛网修剪放置不当、终板刮除过多、术中过度撑开、骨密度下降、选用钢板不适当。术后JOA评分平均增加6.5分(P<0.01),颈椎曲度“D”值平均提高9.25±2.52mm(P<0.05),发生钛网沉陷后18例JOA评分平均增加1.8分,6例平均下降2.1分,“D”值视钛网沉陷发生部位的不同增减不一,但结果均无统计学意义。结论:颈前路钛网植骨融合术后钛网沉陷对颈椎曲度和临床疗效无明显影响;通过合理修剪、放置钛网并使用垫片、椎间适度撑开、保留相邻终板、选用全锁定钢板等措施,可有效防止术后钛网沉陷的发生。     

Single stage anterior reconstruction using titanium mesh cages in neglected kyphotic tuberculous spondylodiscitis of the cervical spine

Cervical tuberculous spondylodiscitis is a serious, hazardous disorder and to our knowledge, hardly any reports focused on the use of titanium mesh cages in its treatment. The aim of this work is to evaluate the efficacy of using a titanium mesh cage compared to iliac crest grafting regarding correction of the deformity, fusion rate and to report the incidence of complications. A prospective, non-randomized multicentre study of 30 patients with cervical tuberculous spondylodiscitis presenting with a neglected kyphotic deformity. The average age was 44.5 years; 18 had neurological deficits. All patients had a single stage radical debridement, decompression, and instrumentation. The anterior column was reconstructed with a titanium mesh cage in 16 patients (Group 1) and an autogenous iliac bone strut graft in 14 (Group 2). Both groups were followed for a minimum of 2 years. Group 1 showed a better sagittal profile and local kyphosis was corrected from an average of 36° (10°–62°) to an average of −6° (+4° to −16°) compared to Group 2 corrected from an average of 30° (6°–48°) to an average of −1° (+2° to −13°). Group 1 patients showed a solid bony fusion without any recurrence of infection while Group 2 showed a higher incidence of nonunion and of persistent donor site morbidity. The use of titanium mesh cages effectively restores the sagittal profile while adding immediate stability. There is no donor site morbidity, recurrence, or persistence of infection associated with their implantation.     

Complications and long-term follow-up results in titanium mesh cage reconstruction after cervical corpectomy

OBJECTIVE: The incidence of the complications and long-term outcome with a minimum 2-year follow-up of anterior cervical reconstruction using titanium mesh cage is evaluated. Relevant literature was also reviewed to discuss the potential risk factors of the complications of this procedure. METHODS: From 1999 to 2003, 26 patients with cervical spine disorders, (12 patients with OPLL, 7 with cervical spondylosis, 3 with vertebral tumors, 2 with osteomyelitis, and 2 with traumatic lesions) were operated on by this procedure. The series included 14 males and 12 females with a mean age of 60.9 years. Corpectomy was performed on 1 (14 cases), 2 (12 cases). Autologous bone fragments were taken from the excised vertebra. RESULTS: The average improvement rate as scored on the neurosurgical cervical spine scale was 67.4%. The average follow-up period was 54.3 months (range, 24 to 72 months) in 21 who were followed up, and bone union was observed in all cases (22/22 cases) that could be followed up for more than 6 months postoperatively. The average time required for fusion was 6.7 months. Postoperative complications included dyspnea (1 case) and cerebrospinal fluid leakage (2 cases), which was treated by lumbar drainage, without any additional repair operation. No hardware-related complications or adjacent segment degenerative changes were encountered during the follow-up periods. CONCLUSIONS: This reconstruction technique yielded good clinical results and helped to avoid complications associated with harvesting bone from the iliac crest donor site. However, risk factors related to the method should be carefully considered.     

双节段颈椎前路椎体次全切除融合术后钛笼下沉的影响因素分析

目的 探讨双节段颈椎前路椎体次全切除融合术(anterior cervical corpectomy and fusion,ACCF)后钛笼(titanium mesh cage,TMC)下沉的影响因素.方法 回顾性分析我院2011年1月至2013年4月收治的86例应用TMC内固定行ACCF患者的颈椎正侧位片及临床资料,随访6个月,根据TMC下沉与否分为下沉组和非下沉组,分析术后TMC下沉与年龄、性别、手术节段、临床疗效、病变节段撑开角度及安置位置的相关性.结果 术后6个月,86例患者中有22例发生TMC下沉(25.6％),下沉组和非下沉组的年龄、性别、手术节段(C5～G)、骨密度、身体质量指数(BMI)之间差异有统计学意义(P＜0.05);两组术后日本骨科协会评分(Japanese Orthopedic Association Scores,JOA)均较术前明显改善,且非下沉组高于下沉组,差异有统计学意义(P＜0.05),但两组融合率的差异无统计学意义(P＞0.05);椎间撑开角度＜30°与≥30°,对下沉发生率的影响不同,差异有统计学意义(P＜0.05);椎体前缘与钛笼前缘间距＜1 mm与≥1 mm,对下沉发生率的影响不同,差异有统计学意义(P＜0.05).结论 椎间撑开角度和安放位置可能是影响TMC术后下沉的重要因素,此外年龄、性别、手术节段(C5～C7)、骨密度、BMI对TMC下沉均有不同程度的影响.     

The use of titanium mesh cages in the cervical spine.

Titanium mesh cages have been used widely for spinal reconstruction since 1986 when they first were introduced. Despite their popularity, relatively few studies have been published on their use in the cervical spine. These cages can be used as structural devices containing autologous local bone or iliac crest bone graft, obviating the need to harvest large structural bone grafts. The main disadvantages of their use are the increased costs and the difficulty of assessing fusion status. The authors review surgical techniques that can be used using titanium mesh cages in cervical spine applications and discuss some of their advantages and disadvantages.     

Efficacy and safety of the use of titanium mesh cages and anterior cervical plates for interbody fusion after anterior cervical corpectomy

BACKGROUND: To determine the safety and effectiveness of the use of titanium mesh cages (TMCs) and anterior cervical plates (ACPs) for interbody fusion after anterior cervical corpectomy. METHODS: From June 2001 to June 2003, 15 patients underwent reconstruction with TMCs and ACPs for interbody fusion after anterior cervical corpectomy in our hospital. The mean follow-up is 13.6 months (range, 9-24 months). Subjects included those with cervical degenerative, traumatic, or pathological diseases. Titanium mesh cages were filled with autologous bone grafts taken from the corpectomy and iliac crest bone chips and were all filled with triosite (calcium phosphate ceramics). The patients' observable signs, neurological reconstruction results, and complications were fully and explicitly recorded throughout the procedure. Radiological imaging studies for measurements of coronal and sagittal angles, sagittal displacements, and settling ratio changes were performed to evaluate spinal stability. We used axial cervical computed tomography (CT) and reconstructive sagittal cervical CT to demonstrate interbody fusion within titanium mesh. RESULTS: The alleviation and frequent disappearance of the subjects' original symptoms and the significant neurological recovery obvious in most patients indicated that postoperative spinal stability could be well maintained. No significant differences in mean cage height-related settling rates, mean sagittal displacements, and mean coronal and sagittal angle changes were observed between 1-level and multilevel corpectomy. All patients who received axial and reconstructive sagittal cervical CT scan could demonstrate true interbody fusion within TMC, and no nonunions were present. Cage malplacement was observed in one subject who had neck pain and neck stiffness, rather than from radiculopathy or myelopathy. One subject died of acute myocardial infarction. There were no ceramic-related complications. CONCLUSIONS: Based on preliminary findings from this study, reconstruction involving TMC interbody fusion with ACP fixation after anterior cervical corpectomy serves as an effective and safe method for the treatment of cervical disease.     

颈前路钛网植骨融合术后钛网沉陷的原因探讨

目的：探讨颈前路钛网植骨融合术后钛网发生沉陷的原因及其对临床疗效的影响，并提出相应对策。方法：回顾性分析在我院行颈前路钛网植骨融合术的各类颈椎疾患患者179例，观察患者骨密度、钛网修剪及放置情况、终板处理情况、钢板类型、植骨及椎体撑开情况等。采用日本骨科学会（JOA）评分法评价神经功能的变化。结果：有17例患者发生钛网沉陷，沉陷的原因主要为骨密度下降、钛网修剪放置不当、术中过度撑开、终板刮除过多、使用非限制性钢板、采用同种异体骨植骨、螺钉进钉深度过浅和方向不当、钢板放置位置偏斜等。术后所有患者JOA评分比术前平均增加3．5分（P〈0．01）。162例未发生钛网下沉患者术后3个月和6个月的JOA评分比术前平均增加4．4分和4．7分：发生钛网下沉患者中。6例有临床症状者沉陷时和沉陷3个月时的JOA评分为2．9分和3．8分．7例无临床表现者为3．3分和3．9分．4例有临床症状行翻修手术者翻修术后1周和3个月时JOA评分比翻修前提高3．3分和3．7分。结论：颈前路钛网植骨融合术后可发生钛网下沉，骨质疏松患者应该避免使用钛网。手术时应尽可能增加钛网与终板接触面积，多保留相邻终板，选用限制性钢板，尽量选择自体骨植骨，避免椎间过度撑开等。防止术后钛网沉陷。     

颈椎前路椎体次全切除术后钛网下沉的原因分析

目的探讨颈椎前路椎体次全切除钛网植骨融合术后钛网下沉的相关因素,提出相对应的改善措施。方法回顾性分析我院96例行颈椎前路椎体次全切除减压钛网钛板植骨融合内固定手术的病例,观察其术前术后的影像学照片、术中钛网的放置情况、椎体撑开的程度、患者的骨密度等。通过JOA评分来评价手术前后患者神经功能改善情况及术后钛网下沉后神经功能的改变情况。结果 96例患者中,术后3个月随访时有18例钛网发生下沉,下沉的原因可能与骨质疏松、钛网修剪放置不当、椎体过度撑开、终板破坏过多等因素相关。通过延长佩戴颈围时间,术后6、9个月随访时,钛网下沉程度无明显加重,术后9个月复查时全部植骨融合。发生下沉的18例患者,与非下沉组相比,JOA评分结果无明显差异。结论颈椎前路钛网发生下沉是颈椎前路手术的常见并发症,一定程度上影响手术疗效,发生钛网下沉的患者,通过延长佩戴颈围,可有效阻止进一步下沉,获得满意的临床疗效。     

Radiological analysis of titanium mesh cages used after corpectomy in the thoracic and lumbar spine: minimum 3 years' follow-up

This study analyses radiological outcome of titanium mesh cages used for anterior column support following corpectomy in the thoracic and lumbar spine in 34 patients with a minimum three-year follow-up. The aim of the study was to assess the complications and radiological outcomes of patients with structural cages implanted into the anterior column. Titanium mesh cages for the anterior column became popular for anterior column reconstruction following discectomy and corpectomy. Few clinical studies are published assessing their efficacy as a structural graft after corpectomy and factors for the development of settling and correction loss are not investigated enough. Thirty-four patients with minimum 3-year follow-up were analysed radiologically for correction achievement, cage settling and fusion inside the mesh cage. The effect of fixation technique, anatomical localisation and diagnosis for the development of settling were analysed. Measurements of preoperative and early postoperative local kyphotic angle revealed that a mean correction of 27 degrees (range: 8 to 60) was obtained. While no dislodgement or fracture of titanium mesh cages was observed, there was a mean correction loss of 4 degrees and settling (> 2 mm) was noted in 6 patients. Short posterior and only anterior instrumentation systems were associated with settling. The anatomical location and diagnosis did not affect the development of cage settling. Following corpectomy and mesh cage implantation, isolated anterior fixation or short posterior fixation do not provide enough stability, and correction loss and settling can occur.     

Complications of multilevel cervical corpectomies and reconstruction with titanium cages and anterior plating

The ideal surgical treatment of multilevel cervical spondylosis remains unclear. This study analyzed the complications in using titanium cages and plating to reconstruct multilevel cervical corpectomies. This was a retrospective analysis of 21 consecutive patients who had multilevel cervical corpectomies and reconstruction with titanium cages and anterior plating. Sixteen had 2-level, one had 2.5-level, three had 3-level, and one had 3.5-level corpectomies. All had reconstruction with titanium cages and anterior plating. Thirty-three percent of the patients developed complications. Radiographs revealed bony consolidation in 95% of patients. Reconstructing multilevel cervical corpectomies with titanium cages and plating is associated with complications. Advantages include rigid immobilization and the avoidance of iliac crest bone graft harvesting. Major complications are largely the result of failures of the cage and plate construct, especially in patients with osteopenic bone. Supplemental posterior stabilization may be considered for cases with spasticity or greater than 2-level corpectomies with profound osteoporosis.     

颈椎单椎体次全切除撑开植骨后即刻运动稳定性测定

目的　观察中下颈椎前路单椎体次全切除减压后不同撑开高度支撑植骨对颈椎即刻运动稳定性的影响 ,为临床手术提供参考。方法　采用 6具新鲜成人尸体颈椎标本 ,对完整状态、C5椎体次全切除减压后 ,C4和C6椎体间以减压槽高度为基础依次撑开 0、2、4、6、8mm支撑植骨 6种状态进行生物力学测试 ,在脊柱三维运动实验机上记录C4、C5和C6椎体的三维运动 ,使用计算机图像处理软件和脊柱运动分析程序测量C4～ 5和C5～ 6节段在各种载荷条件下三维六自由度的运动范围。结果　减压后椎体间撑开 4mm、6mm植骨状态下手术节段的即刻运动稳定性比完整状态及不撑开植骨状态增加 (P <0 0 5 )。结论　中下颈椎单椎体次全切除减压后 ,撑开植骨对手术节段的即刻运动稳定性有重要作用 ,适当的上下椎体间撑开高度为 4～ 6mm。     

颈椎前路椎体次全切除植骨融合术后钛网沉降的危险因素

目的：分析颈椎前路椎体次全切除植骨融合术（anterior cervical corpectomy and fusion,ACCF）后钛网（titanium mesh cages,TMC）沉降的发生率及其危险因素。方法：回顾性分析北京大学第三医院骨科脊柱组2019年1月～2021年12月期间实施ACCF手术的82例脊髓型颈椎病患者,其中男性44例,女性38例,年龄52.4±10.1岁（34～76岁）,随访时间26.6±12.5个月（6～42个月）。根据术后3个月时融合节段高度下降是否超过2.0mm将患者分为沉降组和未沉降组。在术前、术后1d、术后3个月颈椎侧位X线片上测量C2/C7 Cobb角、手术节段Cobb角、椎体间撑开距离、融合节段高度;在术前颈椎CT上测量手术节段近端及远端椎体的CT值,评估骨质疏松情况,记录术前、末次随访的JOA评分,计算JOA评分改善率;将各变量进行单因素分析,将P<0.1的变量及有临床意义的危险因素纳入Logistic回归分析,通过受试者工作特征（receiver operating characteristic,ROC）曲线评价危险因素预测钛网沉降...     

Comparison between anterior cervical discectomy fusion and cervical corpectomy fusion using titanium cages for reconstruction: analysis of outcome and long-term follow-up

Retrospective comparative study of 80 consecutive patients treated with either anterior cervical discectomy fusion (ACDF) or anterior cervical corpectomy fusion (ACCF) for multi-level cervical spondylosis. To compare clinical outcome, fusion rates, and complications of anterior cervical reconstruction of multi-level ACDF and single-/multi-level ACCF performed using titanium mesh cages (TMCs) filled with autograft and anterior cervical plates (ACPs). Reconstruction of the cervical spine after discectomy or corpectomy with titanium cages filled with autograft has become an acceptable alternative to both allograft and autograft; however, there is no data comparing the outcome of multi-level ACDF and single-/multi-level ACCF using this reconstruction. We evaluated 80 consecutive patients who underwent surgery for the treatment of multi-level cervical spondylosis at our institution from 1998 to 2001. In this series, 42 patients underwent multi-level ACDF (Group 1) and 38 patients underwent ACCF (Group 2). Interbody TMCs and local autograft bone with ACPs were used in both procedures. Medical records were reviewed to assess outcome. Clinical outcome was measured by Odom’s criteria. Operative time and blood loss were noted. Radiographs were obtained at 6 and 12 weeks, 6 months, 1 year, and 2 years (if necessary). Early hardware failures and pseudarthroses were noted. Cervical sagittal curvature was measured by Ishihara’s index at 1 year. Group 1 had a mean age 46.2 years (range 35–60 years). Group 2 had a mean age 50.1 years (range 35–70 years).The operative time was significantly lower (P < 0.001) and blood loss significantly higher (P < 0.001) in Group 2 than in Group 1. At a minimum of 1 year follow up, patients in both groups had equivalent improvement in their clinical symptoms. The fusion rates for Group 1 were 97.6 and 92.1% for Group 2. The rates of early hardware failure were higher in Group 2 (2.6%) than in Group 1 (0%). The fusion rates for Group 1 were not significantly higher than Group 2 (P > 0.28). There was one patient in Group 1 and 2 patients in Group 2 with pseudarthroses. Complication rates in Group 2 were not significantly higher (P > 0.341). Cervical lordosis was well-maintained (80%) in both groups. Both multi-level ACDF and ACCF with anterior cervical reconstruction using TMC filled with autograft and ACP for treatment of multi-level cervical spondylosis have high fusion rates and good clinical outcome. However, there is a higher rate of early hardware failure and pseudarthroses after ACCF than ACDF. Hence, in the absence of specific pathology requiring removal of vertebral body, multi-level ACDF using interbody cages and autologous bone graft could result in lower morbidity.     

异形钛笼在中上颈椎腹侧病变切除后稳定性重建中的应用

目的:探讨异形钛笼在中上颈椎腹侧病变切除后重建中的应用。方法:2004年6月~2010年6月收治10例中上颈椎腹侧病变需行病灶切除手术的患者,其中陈旧性结核2例,原发肿瘤5例,转移瘤3例;病变单纯涉及枢椎2例,C2+C3椎体7例,C2~C4椎体1例。术前JOA评分7~14分,平均10分。根据病变范围,在气管插管全麻下,4例患者采用常规单纯经口咽入路清除病灶,6例采用经口唇下颌骨劈开入路清除病灶。所有患者均应用异形钛笼重建椎体,5例行颈椎椎弓根或侧块钉棒固定(C1~C3固定2例,C1～C4固定3例),5例行枕颈钉棒固定(C0~C4固定1例,C0～C5和C0~C6固定各2例);均行自体髂骨植骨融合。观察并发症发生、神经功能改善和植骨融合等情况。结果:10例患者均顺利完成手术,手术时间5～8h,出血量500～3000ml,术中椎体病灶清除顺利,脊髓受压解除彻底,未发生椎动脉、脊髓损伤和脑脊液漏。9例患者获随访,随访3～14个月,平均8个月,术后复查X线、CT结果均提示植骨获得骨性融合;无钛笼移位、松动及切口感染等并发症。术后临床症状得到明显改善,末次随访时JOA评分平均为14分。结论:异形钛笼可重建中上颈椎椎体前柱,联合颈椎后路固定可满意重建颈椎力学稳定性。     

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。     

颈前路椎体次全切术后钛网下沉原因分析及对策研究进展

正颈椎病是指颈椎间盘组织退变及其继发病理改变累及其周围组织结构,出现与影像学改变相应的临床表现~([1])。随着我国逐步走向老龄化社会及人们生活、学习习惯改变,其发病率也越来越高。颈前路减压植骨融合术自20世纪50年代首次报告以来,具有减压彻底和可以扩大椎管的优点,已广泛应用于颈椎多种疾病的治疗,是目前国内外公认的大多数颈椎疾病的首选手术入路~([2、3])。随着颈前路椎体次全切除钛网植骨融合术的应用日益普遍,其缺点也     

两种颈椎植骨重建钛网的临床及影像学比较

[目的]颈前路椎体次全切除术中使用两种植骨重建钛网,评价两者临床及影像学效果.[方法]选取2009年6月～2009年12月行颈前路单椎体次全切手术113例.其中现有钛网63例:男33例,女30例;平均年龄52岁;新型钛网50例:男34例,女16例;平均年龄54岁.术后3、6、12个月随访颈椎X线片,测量融合节段的椎间高度和颈椎曲度,采用日本骨科学会JOA评分系统进行神经功能评价,比较两种钛网手术前后上述方面的差异.[结果]随访观察至术后12个月,现有钛网组椎间高度平均丢失(1.7±0.4)mm,颈椎曲度平均丢失4.9°±0.6°,新型钛网组椎问高度平均丢失(0.4±0.5)mm,颈椎曲度平均丢失0.9°±0.7°,两组之间差异有统计学意义(P＜0.01);现有钛网组患者术后JOA评分神经功能恢复率平均64.9%±3.7%,新型钛网组为67.1%±3.4%,两组间差异无统计学意义(P＞0.05).并发症:现有钛网组长期颈肩部疼痛8例、神经症状复发2例、螺钉断裂2例;新型钛网组仅有2例长期颈肩部疼痛.[结论]新型钛网在维持术后椎问高度和颈椎曲度方面优于现有钛网,而在JOA评分改善率方面优势不明显.