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。

Influences of different anterior cervical fusion and internal fixation on cervical sagittal alignment

Objective To evaluate the influences of different fusion and internal fixation in restoring the sagittal alignment of cervical spine through anterior cervical discectomy with fusion. Methods 67 cases with cervical trauma or other disorders treated with anterior decompression, reconstruction and internal fixation from January 2000 to December 2002. Group A (11 cases), plating bone grafting after discectomy; Group B (15 cases), fusion with cage after discectomy; Group C (19 cases), plate bone grafting after subtotal corpectomy; Group D (22 cases), plating titanium mesh after subtotal corpectomy. The influences on the restoration of cervical alignment were compared respectively between Group A and B, Group C and D according D value(distance from the postero-inferior border of C4 perpendicular to the line drawn from the posterior border of the dens to the postero-inferior border of C7. Results No significant differences were found either between Group A and B (P>0.05) or between Group C and D (P>0.05) immediately postoperation. Fusion were achieved in all cases during the follow up on average of 21.5 months (range, 10 to 36 months), there were also no significant differences on fusion rates either between Group A and B(P> 0.05) or between Group C and D (P>0.05). Significant difference was observed between Group C D and Group A B(P<0.01) in comparing the data from immediate postoperation and follow-up period. Conclusion There is difference in terms of the restoration of cervical sagittal alignment judging by D value with different anterior cervical fusion and internal fixation at the same fusion level. The key factor of restoring the cervical alignment is the correct indication. The restoration of cervical alignment can be achieved intra-operatively rather than postoperatively.