复合骨块在颈椎前路融合中的应用

目的：探讨复合骨块在颈椎融合中的应用价值。方法：回顾分析颈前路减压复合骨块植骨融合28例,观察其术后3个月颈椎间高度的变化,并与常规颈前路减压植骨融合20例比较,结果：复合植骨块融合组在维持颈椎椎间高度及稳定性等方面优于常规组。结论：复合植骨块是一种较好的植骨融合材料。     

同种异体髂骨结合钢板在颈椎前路手术中的应用

[目的]探讨同种异体髂骨块植骨结合前路钢板在颈椎前路椎间植骨融合中的应用效果。[方法]对68例颈椎前路减压植骨融合的患者应用同种异体髂骨块植骨结合前路钢板，记录手术时间、术中出血量及定期X线片等资料，并与同期自体髂骨块植骨结合前路钢板的32例对照组的相关资料进行比较。[结果]同种异体髂骨块植骨结合前路钢板组与同期自体髂骨块植骨结合前路钢板组比较，手术时间以及手术出血量较后者显著减少（P〈0．05），随访1年，两组均成功实现椎体间骨融合，但前者融合时间较后者显著延长（P〈0．05），两组无1例发生钢板断裂或螺钉松动、滑脱。[结论]同种异体髂骨块植骨结合前路钢板，手术时间短，术中出血少，植骨可顺利融合，是颈椎前路手术较好的术式。     

颈前路钛制网状接骨板固定系统的生物力学研究

目的:对自行研制的颈前路钛制网状接骨板固定系统(ACSRP)进行生物力学评价.方法:(1)稳定测试 14例新鲜颈椎标本,随机分为A、B两组,模拟颈椎前路手术制作颈椎双间隙并部分椎体摘除的模型.分别以网状接骨板(ACSRP)和进口Caspar钢板固定,依次测量两类颈椎模型的三维运动数据;(2)植骨块的应力测试选择压力敏感胶片,分别置于A、B两组C4～C6与植入髂骨块之间,计算出其所受应力大小.结果:(1)损伤颈椎在两种钢板固定后的ROM均明显减少,稳定程度增加,但提高颈椎的稳定程度不同;(2)压敏片测量ACSRP固定后的植骨块与Caspar组间应力分布有差异.结论:ACSRP有较好的生物力学稳定作用,ACSRP固定的植骨块较Caspar组固定的植骨块有较好的应力分布.     

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。     

老年患者颈椎体前路切除钛网修复和髂骨植骨的比较

目的比较老年患者颈椎前路次全切术中采用钛网融合和自体髂骨植骨的临床疗效。方法回顾分析62例老年颈椎疾病患者,颈椎前路次全切术中分别采用钛网植骨融合和取自体髂骨植骨融合各为30和32例,比较两组手术参数和术后并发症。结果钛网组和髂骨组在术中出血量、手术时间在老年患者中有显著性差异（P〈0.05）,而在住院时间上无明显差异（P〉0.05）,术后钛网组21例移位,髂骨组2例供区血肿。结论颈前路钛网植骨可减少术中出血及手术时间;而自体髂骨融合效果较好。     

不同植骨方法在颈椎前路融合术中的应用

颈椎前路减压椎间植骨融合术是治疗颈椎及颈椎间盘疾病的常用方法之一。自1996年4月,我们在颈椎前路减压后用自制的异体骨螺纹融合支架(ａｌｌｏｇｒａｆｔｔｈｒｅａｄｅｄｆｕｓｉｏｎｃａｇｅ,ＡＴＦＣ)填充环钻减压时取出的松质骨来替代髂骨植骨,取得满意的效果[1]。与自体髂骨植骨(ａｕｔｏｌｏｇｏｕｓｉｌｉａｃｃｒｅｓｔｇｒａｆｔ,ＡＩＣＧ)比较,作者认为ＡＴＦＣ加自体松质骨植入优于自体髂骨植骨。临床资料　自体髂骨植骨组(ＡＩＣＧ组):1995年3月～1996年3月采用颈椎前路减压加自体髂骨植骨治疗颈椎间盘疾病21例(25节段),年龄4…     

颈椎前路静力性动力性钉板系统在单椎间减压植骨融合中的生物力学研究

[目的]比较颈椎前路静力性、动力性钉板系统在颈椎前路单椎间减压植骨融合中的生物力学,为临床应用提供生物力学依据.[方法]采用6具小牛颈椎标本,测定其正常颈椎C4、5节段的活动范围(ROM) ,而后在C4、5节段制作单椎间减压植骨融合模型后随机分为3组,分别采用Orion、Codman、Window钢板、螺钉固定,分别测定脊柱在前屈、后伸、旋转、侧屈运动时的稳定性并与正常标本比较.[结果]单椎间减压植骨融合后,无论采用哪种钢板固定,其术后ROM值除侧屈时稍大外均比正常颈椎要小,在前屈时最为明显(P< 0.05);后伸时Orion固定最接近正常标本(P> 0.05),而Codman、Window与正常标本相比有较大差异(P< 0.05);旋转侧屈时3 种钢板与正常颈椎均无显著性差异(P> 0.05);3 种钢板之间无显著性差异(P> 0.05) .[结论]在颈椎前路单椎间减压植骨融合中,颈前路静力性、动力性钉板系统均能维持颈椎的稳定性.本试验支持动力性钉板系统在颈椎前路单椎间减压植骨融合中应用.     

前路钢板对两节段颈椎间植骨的运用价值

目的评价前路钢板对两节段颈椎间植骨融合的影响。方法46例两节段颈椎病患者,环锯法切除椎间盘、自体髂骨植骨,其中26例病人用了前路钢板内固定。术后复查X线片,了解植骨融合情况,并评价临床效果。结果26例运用钢板患者,全部获得骨性融合;20例单纯植骨病人,4例出现(20%)假关节,融合节段前凸丢失的度数较植骨融合组明显增大。获得植骨融合的病人,临床结果相似(P>0.05)。结论前路钢板系统增加两节段颈椎间植骨融合率、减少并发症。     

颈椎前路减压带锁钛板内固定治疗颈椎损伤

目的评价颈椎前路减压带锁钛板内固定治疗颈椎骨折并脊髓损伤的临床疗效。方法对46例颈椎骨折并脊髓拟伤的患皙施行颈椎前路臧压、自体髂骨植骨和颈椎带锁钛板内固定。术后定期复查X线片,判定脊髓功能恢复情况,结果随访41例,平均随访时间2．5年。术后3个月植骨块获得骨性融合,颈椎椎间高度和生理曲度维持满意,无内置物并发症,脊髓功能平均提高1级。结论颈椎骨折并脊髓损伤前路减压、应用带锁钛板内崮定有利植骨融合和事建颈椎稳定。     

颈椎病前路不同治疗方法疗效比较

目的分析四种颈椎前路融合术的疗效。方法用四种融合方式对241例因颈椎病患者行前路减压。其中单纯髂骨植骨（A组）单节段40例,双节段22例;颈椎前路减压界面固定术（B组）（cervical interbody fusion cage CIFC）单节段40例。双节段21例;植骨融合并颈椎前路钢板内固定（C组）单节段45例,双节段23例;CIFC并前路钢板内固定（D组）单节段35例,双节段15例。术后定期随访及拍摄X线片,观察疗效、椎间高度、颈椎前弯曲度和融合情况。结果平均随访时间3．2年,经过随访,A组融合率为82．1％,B组融合率为96．3％,C组融合率为95．6％。D组融合率为95．4％。终访时。A组平均椎间高度和颈椎前弯曲度较术后早期显著性降低（P〈0.05）,B组、C组和D组则无显著性差异（P〉0.05）。A组与B、C组和D组之间远期疗效均有显著性差异（P〈0.05）,B组与C组和D组之间远期疗效无显著性差异（P〉0.05）。结论单纯髂骨植骨方法简单,但并发症较多。CIFC、颈椎前路钢板植骨融合内固定和CIFC并前路钢板内固定,固定牢固,符合颈椎生物力学特件并管瘫,p沅期疗特好．     

颈椎前路环锯法减压术后三种处理方法的生物力学评价

目的 研究环锯法减压后不植骨、自体柱状髂骨植骨及螺柱状颈椎内固定器植入后,三者的生物力学稳定性,为临床手术提供依据。方法 采用新鲜青年尸体标本,分别用三种方法处理C5－6段,测量其在1．53nm的纯力矩载荷条件下的稳定性并用相邻椎体间的空间位移和卡当角表示。结果 环锯法减术后,手术节段的稳定性明显减轻。自体髂骨植入后,椎间隙高度升高,伸屈活动度下降,但其稳定性仍比正常时差。螺柱状颈椎内固定器植入,前屈、侧屈和旋转的活动度明显较正常时小,但后伸范围无明显改变。结论 环锯减压后如不植骨有可能不融合或畸形愈合。椎间植骨能明显改善减压节段的稳定性,但手术后仍应采用辅助外固定。螺柱状颈椎内固定器不但能维持椎间隙高度,防止术后畸形,而且有足够的稳定性,术后不必应用外固定。     

帽式颈椎椎间融合器的活体实验研究

目的 本研究在活体山羊颈椎上从椎间支撑能力、二期生物力学稳定性及椎间融合组织学方面比较三面皮质骨、Harms椎间融合器（cage）、Carboncage及自行所研制的帽式颈椎椎间融合器（hat　type　cervical　intervertebral　fusion　cage,HCIFC）的术后效果。方法　取32头山羊随机平均分为4组：第1组自体三面皮质髂骨;第2组Harmscage;第3组Carboncage;第4组HCIFC。分别行C3,4椎间盘切除术并分别植入以上内植物。术后共观察12周并测量平均椎间高度（DSH）、椎间角（IVA）及前凸角（LA）,处死后进行影像学、生物力学及组织学评估。结果 术后1周方盒形HCIFC、Carboncage组的平均DSH、IVA及LA要显著大于垂直圆柱体Harmscage和三面皮质骨组（P〈0．05）;术后12周时3个cage组的平均DSH、IVA及LA显著高于三面皮质骨组（P〈0．05）。垂直圆柱体Harmscage轴向旋转和侧屈时平均刚度显著大于其他组（P〈0．001）,轴向旋转时的最大活动度要显著低于其他组（P〈0．05）。与三面皮质骨组相比,3个cage组的椎间融合效果略好。结论HCIFC的椎间支撑能力、生物力学性能及椎间融合效果均适合于临床使用。     

In vivo experimental study of hat type cervical intervertebral fusion cage (HCIFC)

The purpose of this study was to compare the characteristics of interbody fusion achieved using the hat type cervical intervertebral fusion cage (HCIFC) with those of an autologous tricortical iliac crest graft, Harms cage and the carbon cage in a goat cervical spine model. Thirty-two goats underwent C3-4 discectomy and fusion. They were subdivided into four groups of eight goats each: group 1, autologous tricortical iliac crest bone graft; group 2, Harms cage filled with autologous iliac crest graft; group 3, carbon cage filled with autologous iliac bone; and group 4, HCIFC filled with autologous iliac graft. Radiography was performed pre- and postoperatively and after one, two, four, eight and 12 weeks. At the same time points, disc space height, intervertebral angle, and lordosis angle were measured. After 12 weeks, the goats were killed and fusion sites were harvested. Biomechanical testing was performed in flexion, extension, axial rotation, and lateral bending to determine the stiffness and range of motion. All cervical fusion specimens underwent histomorphological analyses. One week after operation, the disc space height (DSH), intervertebral angle (IVA) and lordosis angle (LA) of HCIFC and carbon cage were statistically greater than those of autologous iliac bone graft and Harms cage. Significantly higher values for DSH, IVA and LA were shown in cage-treated goats than in those that received bone graft over a 12-week period. The stiffness of Harms cage in axial rotation and lateral bending were statistically greater than that of other groups. Radiographic and histomorphological evaluation showed better fusion results in the cage groups than in the autologous bone group. HCIFC can provide a good intervertebral distractability and sufficient biomechanical stability for cervical fusion.     

两种前路减压融合术治疗颈椎间盘突出症的比较

目的对前路颈椎间盘切除减压的碳纤维椎间融合器(cage)植入术与自体髂骨块植骨加钛板固定术治疗单节段颈椎间盘突出症(CDH)进行临床疗效及影像学评估。方法需要手术治疗的单节段CDH患者60例,其中前路减压cage植入术31例,自体髂骨块植骨加钛板固定术29例。术前、术后及随访期间摄X线片,比较两组病例的手术时间、术中出血量、术后并发症、症状改善率、融合时间、融合率、融合节段椎体间高度的维持情况。结果cage植入术较自体髂骨块植骨加钛板固定术手术时间短,出血少(P<0.01)。两组融合节段椎体间高度较术前均明显改善(P<0.01)。两组间症状改善率、融合率无统计学意义(P>0.05)。cage植入术较自体髂骨块植骨加钛板固定术并发症少。结论cage植入术和自体髂骨块植骨加钛板固定术都是前路减压治疗单节段CDH的重要而有效的方法。而cage植入术在减小手术创伤的同时,可以获得同样的临床效果,是治疗单节段CDH理想的术式之一。     

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。     

选择性减压植骨融合内固定联合介入治疗多节段颈椎间盘突出症的临床疗效观察

目的：探讨选择性经前路颈椎间盘切除减压、植骨融合内固定联合临近节段射频消融、臭氧盘内注射微创介入治疗多节段颈椎间盘突出症的临床疗效。方法2010-01-2011-12我院采用选择性减压植骨融合内固定联合微创介入治疗多节段颈椎间盘突出症15例,通过术前查体结合影像学资料确定主次要病变节段,选择性经前路切除主要病变节段椎间盘、椎体次全切除、椎间植骨或钛网植骨融合、钛板内固定术,术中同时对次要病变节段的颈椎间盘行射频消融、臭氧盘内注射等微创介入术。采用JOA评分和贾连顺评定法进行临床疗效评定。结果至末次随访JOA评分为（15.60±0.82）分,与术前比较差异有统计学意义（P〈0.05）。结论选择性减压植骨融合内固定联合微创介入是治疗多节段颈椎间盘突出症的确实有效的术式,中短期随访临床疗效显著。     

The biomechanical and histomorphometric properties of anterior lumbar fusions: a canine model

An in vivo model was developed to compare the biomechanical stability, incidence of radiographic union, bone formation rate, and bone graft remodeling parameters of anterior interbody fusions. Eighteen 1-year-old beagles underwent anterior and posterior spinal destabilization procedures at L5-L6 to produce a reproducible amount of spinal instability--resection of the anterior longitudinal ligament, L5-L6 intervertebral disk, L5 and L6 lamina, spinous processes, zygoopophyseal joints, and ligamentum flavum. Group I (N = 6) were surgically destabilized controls; Group II (N = 6) underwent anterior L5-L6 interbody fusion with iliac crest bone graft; and Group III (N = 6) underwent anterior stabilization with a longitudinal fibular strut graft in addition to the same operative procedure as Group II. Six months postoperatively the group with the highest incidence of successful radiographic L5-L6 arthrodesis was Group III, anterior interbody fusion and fibular stabilization (p less than .10). The rank order of biomechanical stability was the same for the three groups for both torsional and axial compressive stiffness, with Group I (destabilized controls) being the least rigid, then Group II (anterior fusion with iliac crest grafting only), and the most rigid to both torsion and axial compressive loading was Group III (anterior fusion with fibular stabilization and iliac crest bone graft). The bone formation rate [mm3/(mm3 x year) x 10(3)], which was derived from the distance between fluorochrome markers, revealed that the more stable the individual spinal construct, the lower the bone formation rate. In summary, the beagle provided a successful model for studying in vivo the response of anterior bone grafts over a 6-month interval and provided comparative biomechanical and histomorphometric data on spinal interbody fusion techniques.     

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。     

Anterior corpectomy with iliac bone fusion or discectomy with interbody titanium cage fusion for multilevel cervical degenerated disc disease

STUDY DESIGN: Clinical and radiologic study evaluating the outcome after anterior corpectomy with iliac bone fusion compared with discectomy with interbody titanium cage fusion for multilevel cervical degenerated disc disease. OBJECTIVES: To investigate the safety and effectiveness of interbody titanium cage with plate fixation in multilevel postdiscectomy fusion. SUMMARY OF BACKGROUND DATA: The operation for segmental multilevel cervical degenerated disc disease remains controversial. Data on safety and efficacy of titanium cages in multilevel postdiscectomy fusion are rarely available. We investigated the safety and effectiveness of interbody fusion cages with plate fixation and compared the clinical and radiographical results between anterior corpectomy and iliac bone fusion with plate fixation and multilevel discectomy and cage fusion with plate fixation. METHODS: Sixty-two patients were treated with either a multilevel discectomy and cage fusion with plate fixation (27 patients, group A) or an anterior corpectomy and iliac graft fusion with plate fixation (35 patients, group B). We evaluated the patients for cervical lordosis, fusion status, and stability 24 months postoperatively on the basis of spine radiographs. The patients' neurologic outcomes were assessed by the Japanese Orthopedic Association (JOA) scores. Neck pain was graded using a 10-point visual analog scale. RESULTS: Both groups A and B demonstrated a significant increase in the JOA scores (preoperatively 11.1+/-2.1 and 10.4+/-3.5, postoperatively 14.3+/-2.4 and 13.9+/-2.1, respectively) and a significant decrease in the visual analog pain scores (preoperatively 8.5+/-1.1 and 8.7+/-1.5, postoperatively 2.9+/-1.8 and 3.0+/-2.0, respectively). However, there was no significant difference between groups A and B. Both groups A and B showed a significant increase in the cervical lordosis after operation and reached satisfactory fusion rates (96.3% and 91.4%, respectively). Three patients (two 2-level corpectomies and one 3-level corpectomy) had construct failures that required a second operation. Eight of 35 patients who underwent iliac bone fusion had donor site pain. The hospital stay in group A was significantly shorter than that in group B (P=0.022). CONCLUSIONS: Either a multilevel discectomy and cage fusion with plating or a corpectomy and iliac bone fusion with plating provides good clinical results and similar fusion rates for cervical degenerative disc disease. However, absence of donor site complications and construct failures and shorter hospital stay make the multilevel discectomy and cage fusion with plate fixation better than corpectomy and strut graft fusion with plate fixation.     

Anterior cervical discectomy with hydroxylapatite fusion

The outcome of microscopic anterior cervical discectomy with iliac crest interbody fusion in a group of 75 patients was compared with that of microscopic anterior cervical discectomy with synthetic hydroxylapatite fusion in a group of 84 patients. The rate of relief of myelopathy (70%) was similar in both groups, but those who underwent synthetic fusion had better long-term relief of radiculopathy, less need for a second operation at the same or an adjacent level, no resorption of the bone plug, comparable spinal alignment and stability, and the elimination of complications at the iliac crest donor site. The data suggest that hydroxylapatite fusion may be equal or superior to autologous iliac crest interbody fusion for anterior cervical disc surgery.