钛质外科网和自体髂骨块在颈椎前路减压融合术中应用的对比性研究

目的:比较钛质外科网(简称“钛网”)与自体髂骨块在颈椎前路减压融合术中恢复、维持颈椎曲度及椎间高度上的差异。方法:对59例确诊为脊髓型颈椎病的患者行颈椎前路减压融合术,其中22例行钛网植骨加AO纯钛带锁钢板内固定,37例行自体髂骨块植入加AO纯钛带锁钢板内固定。分别摄术前、术后即刻、术后随访时的颈椎标准侧位X线片,以Cobb角测量融合节段的前凸(或后凸),以D值评价颈椎的前凸(或后凸),同时测量融合节段椎体前缘高度(HAB)、后缘高度(HPB)。对各参数不同时期间差值分别行组间配对t检验。结果:经9~18个月随访(平均10.8个月),所有病例均获骨性融合。术后3个月钛网组及自体髂骨块组融合节段后高(HPB)和前凸Cobb角相对于术后即刻变化有显著性差异(P<0.01);术后6个月钛网组及自体髂骨块组融合节段后高(HPB)和前凸Cobb角相对于术后3个月变化有显著性关(P<0.01)。但两组的D值无显著性差异。结论:在维持融合节段椎体后缘高度和前凸上钛网优于自体髂骨块,但在维持颈椎曲度上无显著性差异。     

颈前路钛网植骨及带锁钢板固定治疗下颈椎骨折

目的评价颈椎前路钛网植骨及带锁钢板固定治疗下颈椎骨折的临床应用价值。方法 2005年5月～2012年12月共收治下颈椎压缩性及爆裂性骨折患者32例,其中颈脊髓损伤患者28例,采用前路减压复位椎体次全切除、钛网植骨及带锁钢板固定方法一期手术治疗。按照Frankel评分系统对神经功能恢复情况进行评价,以X线片测量的Cobb角、"D"值改变评价复位效果、观察融合节段曲度及颈椎生理曲度重建和维持情况。结果不完全脊髓损伤患者Frankel评分恢复平均1级以上。Cobb角、"D"值测量统计表明术前与术后差异有统计学意义(P<0.05),术后即刻与术后随访差异无统计学意义(P>0.05)。结论颈前路钛网植骨及带锁钢板固定治疗下颈椎骨折临床疗效满意,能重建和维持颈椎生理曲度。     

前路融合内固定方式对颈椎曲度的影响

目的分析颈椎前路减压融合术中,不同植骨融合内固定方式对恢复颈椎生理曲度的影响。方法2000年1月～2002年12月施行颈椎前路减压内固定手术治疗颈椎伤病患者67例,将26例单节段减压内固定病例分为前路钢板 髂骨植骨融合组(A组,11例)及Cage植骨融合组(B组,15例);将41例多节段(双或三节段)椎体次全切除减压内固定病例分为钢板 髂骨植骨融合组(C组,19例)及钢板 钛网植骨融合组(D组,22例)。以D值法(颈椎侧位X线片上,C4椎体后下缘到齿突后缘与C7椎体后下缘连线的垂直距离)分别比较A、B两组及C、D两组在恢复颈椎生理曲度方面的疗效。结果术后即刻A、B两组及C、D两组之间D值的增值差异无显著性(P >0.05)。全部病例随访10～36个月(平均21.5个月),均获骨性融合。A、B两组及C、D两组之间末次随访时D值增值差异无显著性(P >0.05),各组内术后即刻与末次随访时D值增值的差异无显著性(P >0.05),多节段减压组(C D组)与单节段减压组(A B组)D值增值在术后即刻与随访时差异均有显著性(P< 0.01)。结论在均行单节段或多节段减压融合的病例中,采用不同的前路融合内固定方式对恢复颈椎曲度无明显影响,由此推断正确掌握前路手术适应证是有效恢复颈椎生理曲度的首要因素,恢复颈椎生理曲度的关键步骤在术中而非术后。     

前路带锁钢板联合钛笼植骨融合术治疗下颈椎骨折脱位

目的评价前路带锁钢板系统结合钛笼内植骨融合治疗颈椎骨折脱位合并脊髓损伤的临床疗效及应用价值。方法对25例颈椎骨折脱位并脊髓损伤患者行颈椎前路减压、钛笼内植骨,纯钛带锁钢板内固定术,神经功能按JOA评分,于术前、术后1年余对所有病例均进行评分。结果25例患者全部获得随访,平均随访时间15．5个月。骨折、脱位复位均满意,植骨于术后3个月融合,无钢板螺钉松动、断裂、钛笼陷入椎体内等并发症,术后1年JOA评分恢复率为（69．2±12．5）％。结论应用前路带锁钢板系统结合钛笼内植骨融合术治疗颈椎骨折脱位,能充分保证固定节段的稳定性,植骨融合率高,有效地维持了椎问高度和生理曲度,使脊髓在相对生理环境下达到最大程度的功能恢复,在颈髓损伤中有较大的应用价值,远期效果还有待于进一步观察。     

前路手术治疗无脊髓损伤的Allen-Ferguson Ⅱ度及Ⅲ度下颈椎损伤

目的探讨前路手术治疗无脊髓损伤的Allen-FergusonⅡ、Ⅲ度下颈椎骨折脱位的临床疗效和安全性。方法 2013年6月-2015年6月,采用单纯经前路减压、复位及椎间植骨融合内固定术治疗25例无脊髓损伤的Allen-FergusonⅡ、Ⅲ度下颈椎骨折脱位患者。男17例,女8例;年龄31~57岁,平均41.2岁。致伤原因:高处坠落伤11例,摔伤5例,砸伤6例,交通事故伤3例。新鲜骨折24例,陈旧性骨折1例。神经功能Frankel分级:D级6例,E级19例。损伤节段:C 4、5 5例,C 5、6 14例,C 6、7 6例。关节突交锁:单侧9例,双侧16例。记录手术时间、术中出血量及并发症发生情况,采用Odom标准评价临床疗效。X线片复查,观测Cobb角、D值(颈椎后凸或前凸程度)的变化及植骨融合情况。结果患者均顺利完成手术;手术时间66~115 min,术中出血量80~220 m L。25例均获随访,随访时间12~36个月,平均19.3个月。术后1例发生一过性吞咽困难,2例发生供骨区疼痛;无其他并发症发生。术前神经功能Frankel D级者均于3个月内恢复至E级。X线片复查示植骨均融合;颈椎间高度无丢失,未发生内植物松动、断裂。术后3个月参照Odom标准评价临床疗效,获优18例,良6例,可1例,优良率96.0%。术后Cobb角和D值均较术前显著改善(P0.05);术后即刻、6周、3个月、6个月间比较差异均无统计学意义(P0.05)。结论单纯经前路手术治疗无脊髓损伤的Allen-FergusonⅡ、Ⅲ度下颈椎骨折脱位患者临床疗效好,安全性高,创伤小,术后康复快。     

颈前路植骨融合内固定术治疗不稳定性Hangman骨折

目的 探讨颈前路植骨融合内固定术治疗不稳定性Hangman骨折的疗效和应用价值。方法 对6例不稳定性Hangman骨折患者行颈前路植骨融合，Zephir颈前路钢板系统内固定术。术后进行10～18个月(平均14个月)随访。结果 术后症状明显恢复。全部病例颈椎生理前凸维持良好，C2椎弓骨折线模糊。术后6个月植骨融合率达到100％。无内固定系统松动和断裂现象存在。结论 应用颈前路植骨融合内固定术治疗不稳定性Hangman骨折具有可获得术后上颈椎即刻稳定，防止植骨块移位，无须行石膏固定，维持颈椎生理前凸，促进骨折愈合和植骨融合率高等优点。     

前路切开复位治疗下位颈椎骨折脱位

目的探讨颈椎前路手术在治疗颈椎损伤中的应用价值。方法27例颈椎损伤患者术前不作复位牵引。采用颈椎前路切开复位、自体髂骨植骨及带锁钢板内固定术。观察植骨融合率、椎间高度和曲度维持情况,结合术前和术后1年Frankel神经功能评估方法了解手术疗效。结果27例均获得随访,时间12～37个月。植骨融合率100%,椎间高度和生理曲度在术后2个时间点差异无显著性,无手术相关并发症,无神经损伤加重现象。术后Frankel分级：A级1例无恢复;B级4例恢复至C级2例、D级1例,1例无恢复;C级6例恢复至D级4例、E级2例;D级14例恢复至E级11例,3例无恢复;E级2例仍为E级。结论颈椎前路带锁钢板治疗颈椎骨折脱位可显著提高植骨融合率,并有效维持椎间高度和颈椎生理曲度。经MR I检查确认无椎间盘突出者可以慎重选择后路手术,如同时合并椎间盘突出和椎板骨折者应考虑行前后路联合手术。     

前路手术治疗严重下颈椎骨折脱位

目的：探讨前路手术在治疗严重下颈椎骨折脱位中的价值。方法：32例严重下颈椎骨折脱位均在全麻下行颈前路减压、复位、自体髂骨植骨及AO颈椎带锁钢板固定。结果：完全复位17例,复位90%以上15例,平均随访28个月,颈椎椎间高度和生理曲度维持良好,无钢板螺钉并发症,21例脊髓不完全损伤者神经功能获得改善。结论：严惩下颈椎骨折脱位选择前路手术治疗可获得满意的复位和即刻稳定性的重建。     

脊髓型颈椎病前路三种术式的中期疗效比较

目的:比较三种颈椎前路手术治疗脊髓型颈椎病的中期疗效.方法:132例脊髓型颈椎病患者,44例行环锯法颈椎前路减压植骨融合术(一组),48例行颈椎前路减压自体植骨加带锁钢板固定术(二组),40例行颈椎前路减压界面固定术(CIFC)(三组).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:经过平均30个月的随访,一组融合率为82.69%,二组融合率为92.86%,三组融合率为95.24%.终访时,一组平均椎间高度和颈椎前弯曲度较术后早期显著性降低,二组和三组则无明显性差异.一组与二、三组之间中期疗效均有显著性差异,二组与三组之间中期疗效无显著性差异.结论:脊髓型颈椎病患者行前路手术时带锁钢板固定和界面固定均可使颈椎融合节段获得术后即刻稳定,提高骨性融合率,维持术后椎间高度和颈椎前弯曲度,并能维持脊髓减压效果,与环锯法颈椎前路减压植骨融合术相比具有较好的中期疗效.     

颈椎前路融合节段相邻椎间盘压力与轴性症状关系初探

目的分析在生理前凸获得有效重建的颈椎前路减压融合术中,融合节段相邻椎间盘压力变化与颈椎术后轴性症状发生的关系。方法行前路单椎体次全切除减压内固定手术治疗颈椎伤病42例,术中测量融合节段相邻椎间盘内压力,计算颈椎融合前后压力差。以D值法(C4椎体后下缘到齿状突后上缘与C7椎体后下缘连线的垂直距离,正值表示前凸)测量手术前后颈椎曲度变化,同时观察术后轴性症状的发生。分析颈椎曲度及相邻椎间盘压力变化与术后发生轴性症状的相关性。结果全部病例术后D值均为正值,与术前差异有显著性(P<0.05)。术后颈椎曲度变化与轴性症状发生无相关性(P>0.05),而相邻椎间盘压力变化与轴性症状发生有显著相关性(P<0.05)。术后发生轴性症状组(12例)相邻椎间盘压力差与无轴性症状组(30例)差异有显著性(P<0.05)。结论在生理前凸获得有效重建的颈椎前路减压融合术中,融合节段相邻椎间盘压力变化与术后轴性症状发生的关系密切。术中相邻椎间盘压力监测有助于准确掌握撑开程度,减少术后轴性症状的发生。     

颈椎前路手术后翻修术

目的:对颈椎前路手术后翻修术的适应证和手术方式进行探讨,评价前路内固定在颈椎翻修术中的应用价值。方法:我院1998~2002年有43例颈椎前路手术后患者进行了翻修术,重新从前路行减压、植骨及内固定。分析其翻修原因、临床表现、手术方式及术后疗效,并对术前、术后及随访时的影像学资料进行测量及评价。结果:因并发食道瘘死亡1例,失访2例,40例获得1~4年(平均33个月)随访,除2例因假关节形成融合失败外,其余38例均获牢固骨性融合,术后12周内融合者24例,12～24周内融合者14例。术前与术后即刻、术前与术后随访时“D”值有显著性差异(P<0.01);术后即刻与术后随访时“D”值无显著性差异(P>0.05)。结论:颈椎前路翻修术在临床疗效、恢复和维持颈椎生理曲度方面效果满意。     

多节段颈椎病不同手术方法的比较

目的 探讨多节段颈椎病手术治疗方案的选择及前路手术的临床应用价值。方法 对132例多节段颈椎病患者，采用前路手术方法治疗113例，后路手术方法治疗11例，前后路联合手术方法治疗8例。观察患者神经功能改善、颈椎椎间高度和颈椎生理曲度恢复和重建。结果 所有患者术后JOA评分均有改善，前路手术方法治疗组JOA改善率为58．5％，后路手术方法治疗组54．6％；前后路联合方法治疗组56．8％；各手术组患者颈椎Cobb角、D值术后与术前比较均有显著性差异（P〈0．01）；椎间高度前路手术方法术后与术前比较有显著性差异（P〈0．01），后路手术方法术后与术前比较差异无统计学意义（P〉0．05）；前路与后路Cobb角、D值、椎间高度差值比较有显著性差异（P〈0．01）。结论 多节段颈椎病患者的手术治疗能显著改善其神经功能，颈前路手术方法椎间高度及生理曲度恢复和重建优于颈后路手术方法。     

Prediction of postoperative alignment in patients undergoing anterior cervical fusion using autologous vertebral bone grafting

Cervical anterior fusion is useful for the treatment of patients with cervical disease, but carries the risk of postoperative worsening of the cervical spine alignment and kyphosis. Preoperative prediction of the risk for kyphosis could help to avoid such postoperative complications. We attempted to predict the postoperative development of kyphosis in 59 patients scheduled for cervical anterior fusion using autologous vertebral bone grafting. Of these, 36 underwent single and 23 two level fusion with median follow up of 58.2 months. Whole spine alignment, fused segment alignment, and mobility of the intervertebral disc were compared using pre- and postoperative radiographs. Alignment of the whole spine changed from 13.7 degrees to 11.1 degrees , and the angle of the fused segment changed from 3.6 degrees to -3.2 degrees . Postoperative alignment was not worse than the preoperative flexion posture in any of the 59 patients. Forty-nine patients with preoperative lordotic alignment did not develop postoperative kyphosis. Nine patients with preoperative straight alignment had several types of postoperative alignment, including kyphosis. Two patients with postoperative kyphosis showed marked loss in the angle of the fused segment, which affected mobility to flexion of the fused segment. One patient with preoperative kyphotic alignment manifested postoperative kyphosis. The postoperative alignment was influenced by the preoperative alignment. Kyphosis may develop in patients with preoperative straight alignment and large mobility to flexion of the fused segment. This information is useful for surgical planning of anterior cervical fusion using autologous vertebral bone grafting.     

下颈椎骨折脱位并脊髓损伤的前路手术治疗

目的探讨前路手术在治疗下颈椎骨折脱位并脊髓损伤中的价值。方法168例下颈椎骨折脱位并脊髓损伤患者均在全麻下行颈前路减压、复位、钛网或自体髂骨植骨及颈椎带锁钢板固定。结果完全复位151例,复位90%以上17例。平均随访80.7个月,颈椎椎间高度和生理曲度维持良好,无钢板螺钉并发症。140例脊髓损伤者神经功能获改善。结论下颈椎骨折脱位并脊髓损伤选择前路手术治疗可获得满意的疗效。     

The long-term results of anterior surgical reconstruction in patients with postlaminectomy cervical kyphosis

Background contextPostlaminectomy kyphosis of the cervical spine is a challenging condition to treat because it has a combination of an exposed cord, progressive kyphosis, segmental instability, and anterior neural compression. The ideal mode of surgical correction remains controversial. In terms of surgical strategy, there are few large series that have reported the long-term results of anterior surgical treatment of this condition.PurposeThis study was designed to determine the long-term results and outcomes of anterior surgical treatment alone for the patients of postlaminectomy cervical kyphosis.Study design/settingThis is a retrospective review of prospectively collected data in an academic institution.Patient sampleThe sample comprises 23 patients who underwent anterior reconstruction surgery for the treatment of postlaminectomy kyphosis.Outcome measuresThe outcome measures were neck disability index (NDI), visual analog scale (VAS) for neck and arm pain, Nurick grades, kyphosis angles, fusion status, and complications.MethodsTwo independent spine surgeons reviewed the completed medical records and radiographs of 23 patients who had undergone multilevel anterior cervical hybrid decompression (corpectomy and discectomy) with instrumented fusions for postlaminectomy kyphosis by one surgeon at an academic institution. The clinical and radiographic outcomes were measured by NDI, VAS for neck and arm pain, Nurick grades, kyphosis angles, and fusion status at the time of preoperative, postoperative, and the last follow-up.ResultsThe mean follow-up was 44.5±31.0 months (range 24–120 months). The average preoperative kyphosis of 20.9° was significantly improved to a lordosis of 14.0° after surgery (p<.0001) and was maintained to a lordosis of 9.6° at the final follow-up (p<.0001). The average correction angle of kyphosis was 30.5±11.7°. The average preoperative, NDI, VAS, and Nurick grades were significantly improved at the last follow-up (all, p<.0001). The average levels of 0.9±0.7 corpectomy, 2.0±0.9 discectomy, and 3.8±1.4 anterior fusions were performed in each patient. Solid fusion was confirmed by computed tomography in all patients at a mean time of 3.8±1.2 months. There were six (26%) patients and seven (30.4%) complications: four (14.3%) graft-related complications (one implant displacement, one graft dislodgment, and one pseudarthrosis), one swallowing difficulty, one wound infection, one dura tear, and one pneumonia.ConclusionsOur data suggest that multilevel anterior surgical treatment using hybrid decompression (corpectomy and discectomy) combined with instrumented fusion yields acceptable clinical and neurological improvement and effective correction of cervical kyphosis. The techniques used also appeared to decrease the incidence of graft-related complications compared with a previous report by the same author.     

颈椎前路钢板在脊髓型颈椎病前路手术中的作用

目的 评价内固定在脊髓型颈椎病前路减压中的作用。方法 143例脊髓型颈椎病患者经前路减压后自体髂骨植骨，带锁钢板内固定。获得随访病例132例，随访时间平均20个月，观察术后神经功能恢复情况，植骨融合率，椎间高度及颈椎生理曲度恢复情况。结果 单节段与两节段病变者术后3月均获得骨性愈合，融合率为100％，16例3节段病变者融合体为81．3％，内固定并发症为5／132(3．8％)。术后椎间高度与生理曲度均获得满意重建。JOA记分平均改善率65．8％。结论 在脊髓型颈椎病前路减压手术中应用带锁钢板内固定可有效维持椎间高度和生理曲度，并有助于后路间接减压。     

Effects of a cervical disc prosthesis on maintaining sagittal alignment of the functional spinal unit and overall sagittal balance of the cervical spine

The object of this study is to review the early clinical results and radiographic outcomes following insertion of the Bryan Cervical Disc Prosthesis (Medtronic Sofamor Danek, Memphis, TN), together with its effect on maintaining sagittal alignment of the functional spinal unit (FSU) and overall sagittal balance of the cervical spine for the treatment of single-level or two-level symptomatic disc disease. Forty-seven patients with symptomatic single or two-level cervical disc disease who received the Bryan Cervical Artificial Disc were reviewed prospectively. A total of 55 Bryan disc were placed in 47 patients. A single-level procedure was performed in 39 patients and a two-level procedure in the other eight. Radiographic and clinical assessments were made preoperatively and at 1.5, 3, 6, 9, 12, and 18 and up to 33 months postoperatively. Mean follow-up duration was 24 months, ranging from 13 to 33 months. Periods were categorized as early follow up (1.5–3 months) and late follow up (6–33 months). The visual analogue scale (VAS), neck disability index(NDI), Odom’s criteria were used to assess pain and clinical outcomes. Static and dynamic radiographs were measured by hand and computer to determine the range of motion (ROM), the angle of the functional segmental unit (FSU), and the overall cervical alignment (C2–7 Cobb angle). With all of these data, we evaluated the change of the preoperative lordosis (or kyphosis) of the FSU and Overall sagittal balance of the cervical spine during the follow-up period. There was a statistically significant improvement in the VAS score from 7.0 ± 2.6 to 2.0 ± 1.5 (paired-t test, P = 0.000), and in the NDI from 21.5 ± 5.5 to 4.5 ± 3.9 (paired-t test P = 0.000). All of the patients were satisfied with the surgical results by Odom’s criteria. The postoperative ROM of the implanted level was preserved without significant difference from preoperative ROM of the operated level. Only 36% of patients with a preoperative lordotic sagittal orientation of the FSU were able to maintain lordosis following surgery. However, the overall sagittal alignment of the cervical spine was preserved in 86% of cases at the final follow up. Interestingly, preoperatively kyphotic FSU resulted in lordotic FSU in 13% of patients during the late follow-up, and preoperatively kyphotic overall cervical alignment resulted in lordosis in 33% of the patients postoperatively. Clinical results are encouraging, with significant improvement seen in the Bryan Cervical Artificial disc. The Bryan disc preserves motion of the FSU. Although the preoperative lordosis (or kyphosis) of the FSU could not always be maintained during the follow-up period, the overall sagittal balance of the cervical spine was usually preserved.     

Effects of anterior contralateral cervical microdiskectomy on radiological and clinical outcome

BACKGROUND: We have conducted a prospective study to investigate the relationship between cervical spine alignment and clinical outcome in 102 patients undergoing anterior contralateral microdiskectomy without interbody graft or cage. METHODS: Preoperative and postoperative lateral cervical radiographs were obtained, and curvature of the surgically treated spinal segments and the overall curvature of the cervical spine were evaluated in all patients. Clinical outcomes were assessed using the NDI and SF-36. RESULTS: There was no significant change in the mean overall cervical curvature (C2-C7) angles postoperatively in late follow-up findings (P = .72). It represented a statistically significant mean loss of 2.73 degrees of segmental lordosis (P < .0001). The NDI scores decreased significantly in both early and late follow-up evaluations, and the SF-36 scores demonstrated significant improvement in late follow-up results in our series. Analysis of clinical outcome showed no statistical differences between patients with segmental lordosis or kyphosis. CONCLUSION: Despite the kyphosis seen at the treated levels, the overall alignment between C2 and C7 did not change significantly, indicating that the untreated segments of the cervical spine were compensating for focal kyphosis.