PEEK材料椎间融合器或加用钢板椎间融合术治疗脊髓性颈椎病的疗效分析

目的观察分析应用PEEK材料椎间融合器（Cage）或加用钢板椎间融合术治疗脊髓型颈椎病的疗效。方法 2006年以来应用PEEK材料Cage或加用钢板椎间融合术治疗脊髓型颈椎病27例49节段：单节段11例：C3-4者2例,C4-5者2例,C5-6者6例,C6-7者1例;双节段10例：C4-5和C5-6者6例、C5-6和C6-7者4例;三节段6例：C3-4、C4-5、C5-6者：3例,C4-5、C5-6、C6-7者：3例;Cage植骨融合11例,钢板植骨融合9例,Cage联合钢板融合7例;手术前后应用JOA评分判定手术效果。结果本组平均随访24.3（6～54）]个月,临床效果：JOA评分术前为平均6.8±2.2（3～11）]分,术后末次随访时JOA评分为12.9±1.4（10～15）]分,较术前增加（6.1±1.8）分,差异有统计学意义（P〈0.05）,平均改善率为（59.1±10.5）%（P〈0.05）,优良率为81.5%。颈椎生理曲度：末次随访时颈椎生理曲度值较术前增加（7.8±5.1）mm,其中Cage植骨融合、钢板植骨融合、Cage联合钢板融合分别增加（7.7±6.1）mm（、7.0±3.9）mm、（9.1±5.4）mm,差异有统计学意义（P〈0.05）。融合节段高度：末次随访时分别比术前平均增加（2.7±1.8）mm,与术前差异有统计学意义（P〈0.01）,其中钢板植骨融合、Cage植骨融合及Cage联合钢板融合节段高度分别比术前平均增加（2.3±1.6）mm（、2.8±2.2）mm（、3.0±1.3）mm,P〈0.05,P〈0.05,P〈0.05。椎间融合率：术后末次随访时椎间融合率100%,颈椎稳定性好,无下沉、移位等并发症发生,椎间高度未发生再丢失,钢板及螺钉无折断。结论应用PEEK材料椎间融合器及加用钢板治疗脊髓型颈椎病的效果满意,能够维持和提高颈椎曲度和融合节段高度。

Clinical Efficacy of Cervical Spondylotic Myelopathy Applying with materials PEEK Intervertebral Fusion Cage or Plate Fixation in Anterior Cervical Decompression Operation

Objective To investigate the clinical efficacy in the treatment of cervical spondylotic myelopathy applying with the materials PEEK intervertebral fusion cage or with the plate fixation in anterior cervical decompression operation. Methods Since 2006,27 patients 49 segments with cervical spondylotic myelopathy underwent the surgery of anterior cervical decompression,bone graft and interbody fusion with cage or plate fixation：single segment in 11 patients：C3-4、C4-5、C5-6、C6-7 in 2,2,6,1 patients;Double segments in 10 patients：C4-5、C5-6 in 6 patients,C5-6、C6-7 in 4 patients;Three segments in 6 patients：C3-4、4-5、C5-6 in 3 patients,C4-5、C5-6、C6-7 in 3 patients;Cages with bone graft and interbody fusion in 11 patients,plate fixation with bone graft and interbody fusion in 9 patients,cage with plate fixation in 7 patients;JOA scores was used for cord function evaluation. Results The patients were followed up for 24.3（6～54） months on average.Clinical effect：the JOA scores were 6.8±2.2（3～11）]pionts in average preoperation,and the JOA scores were 12.9±1.4（10～15）]points after operation,increased（6.1±1.8） points,with statistically significance.The rate of excellent and good results was 81.5%;cervical physiological curvature：at final follow-up,the cervical physiological curvature increase（7.8±5.1）mm,cages with bone graft、plate fixation with bone graft、cage with plate fixation increase separately（7.7±6.1）mm、（7.0±3.9）mm、（9.1±5.4）mm,with statistically significance（P0.05）.The height of fusion segments：compared with preoperative,the height of fusion segments increases（2.7±1.8）mm at final follow-up,with statisticall significance（P0.05）.Cages with bone graft、plate fixation with bone graft、cage with plate fixation increase separately（2.3±1.6）mm,（2.8±2.2）mm,（3.0±1.3）mm,P0.05,P0.05,P0.05.Intervertebral fusion rate：the intervertebral fusion rate was 100% at final follow-up.The stability was good,no complication such as submersion,shifting,the height of fusion segments has not occurred lose again,and no complication related to implant occured. Conclusion The clinical efficacy in the treatment of cervical spondylotic myelopathy applying with the materials PEEK intervertebral fusion cage or with the plate fixation in anterior cervical decompression operation are satisfactory,can maintain and enhance the cervical vertebra curvature and the height of fusion segments.