自体椎体骨钛网支架融合器在颈椎病治疗中的应用

目的　探讨前路钛网支架自体椎体骨移植替代髂骨进行颈椎前路减压融合治疗脊髓型颈椎病的可行性。方法　采用颈椎前路开槽减压钛网支架自体椎体骨颗粒嵌压植骨结合前路钛钢板固定治疗颈椎病 2 8例。分型 :脊髓型 1 8例 ,神经根型 5例 ,混合型 5例。累及二个椎间隙 2 3例 ,三个椎间隙 5例。在前路减压完成后 ,选择合适长度和直径的钛网支架植入 ,其中加压填充术中所取椎体骨颗粒 ;前路钛钢板固定以获得早期稳定。按JOA评分评定手术效果 ,颈椎正侧位及屈伸位X线检查判定融合效果。结果　JOA评分从术前 (1 2 6 2± 1 5 4 )提高到术后 (1 5 1 2± 1 2 5 )分 ,无一例患者症状加重 ;按照Odom标准评定 ,优良率达 89%。经X线片检查证实椎体间隙高度得到恢复 ,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。 1例钢板位置不正 ,1例 2枚螺丝钉进入椎间隙 ,未引起不良并发症。结论　脊髓型颈椎病前路手术中采用钛网包容的自体椎体骨颗粒行植骨融合结合前路钛钢板固定术可替代自体髂骨融合术 ,治疗效果近期是肯定的。可以缩短手术时间 ,避免取髂骨的并发症

Vertebral Autograft Compacted in Titanium Mesh Cage Used As Bone Transplant for Anterior Cervical Corpectomy

Objective To evaluate the efficacy of vertebral autograft compacted in titanium mesh cage for cervical spondylosis patients treated by anterior cervical corpectomy (ACC) with anterior instrumentation.Methods Twenty eight patients were performed for cervical spondylotic myelopathy caused by multi segmental cervical spondylosis.After the anterior corpectomy 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.The 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 86% of the patients.The mean preoperative JOA score improved from 12 62 to 15 12postoperatively (P<0 05).No patient demonstrated worsening of myelopathic symptoms.Radiological follow up studies demonstrated complete bony fusion in all patients.In patients with either a lordotic or neutral cervical spinal axis postoperatively,the axis remained unchanged during the entire follow up period.Conclusion Transplantation of autograft bone material harvested during the operation integrated well in the cage and in the adjacent vertebral bodies.This methds is safe and efficacious and can avoid the complications associated with explantation of autograft material from other donor sites,e.g.,the iliac crest.