3D打印解剖型钛笼与传统钛笼在ACCF术中应用的比较研究

目的评估3D打印解剖型钛笼在单节段颈椎前路椎体次全切除植骨融合(ACCF)术中应用效果及其安全性。方法回顾性分析自2014-06—2015-12行C5椎体ACCF的56例脊髓型颈椎病,27例ACCF术中应用3D打印解剖型钛笼(观察组),29例ACCF术中应用传统钛笼(对照组)。比较2组手术时间、术中出血量、JOA评分改善率。术后3 d及末次随访于颈椎正侧位X线片上观察钛笼下沉距离、骨融合及融合节段Cobb角。结果 56例均获得随访,观察组随访时间(15.34±3.61)个月,对照组随访时间(15.42±2.98)个月。所有患者均达到骨性融合,融合率100%。观察组21例钛笼下沉,下沉0.3~0.7(0.52±0.21)mm,无严重下沉患者;对照组25例钛笼下沉,下沉2.3~4.2(2.93±0.42)mm,3例严重下沉;观察组钛笼下沉距离小于对照组,差异有统计学意义(P0.05)。观察组末次随访时JOA评分改善率为69.5%,对照组为67.0%,2组差异无统计学意义(P0.05)。观察组融合节段Cobb角小于对照组,差异有统计学意义(P0.05)。结论 3D打印解剖型钛笼在ACCF治疗单节段脊髓型颈椎病术中应用能够获得与传统钛笼相似的临床效果及骨性融合率,并且可以有效减少钛笼下沉现象,使用安全。

Comparative study of a new 3D anatomical titanium cage and traditional titanium cage in anterior cervical corpectomy and fixation

Objective To evaluate the clinical efficacy and safety of a new 3D anatomical titanium cage in single-segment anterior cervical corpectomy fixation (ACCF) and bone grafting.Methods From June 2014 to December 2015,fifty-six cases of cervical spondylotic myelopathy were analyzed retrospectively.All patients underwent C5 ACCF and titanium cage implantation.Among these cases,27 cases were included in 3D anatomical titanium cage group (observation group) and 29 cases in traditional titanium cage group(control group).The time of operation and bleeding volume were compared between the two groups.The changes of JOA score and the improvement rate were compared before and after operation.The cage subsidence degree,bone fusion and Cobb angle changes were also studied in the X-ray at 3 d after operation and final follow-up.Results Fifty-six patients were followed up,the average follow-up time were (15.34±3.61)months and (15.42± 2.98)months in the observation group and control group respectively.All patients achieved bone fusion,and the fusion rate was 100％.Cage subsidence and mean subsidence in observaion/control group were 21/25 patients,0.3-0.7 (0.52±0.21)mm/2.3-4.2 (2.93±0.42)mm respectively,there was no severe subsidence in observation group while severe subsidence was found in 3 patients in control group.The distance of cage subsidence in observation group was smaller than that in the control group (P ＜0.05).The improvement rate of JOA score at the final follow-up was 69.5％ in the observation group and 67.0％ in the control group,there was no significant difference between the two groups (P ＞0.05).The Cobb angle of the fusion segment in the observation group was smaller than that in the control group,the difference was statistically significant (P ＜0.05).Conclusion Compared with the use of traditional titanium cage in treatment of cervical spondylotic myelopathy with single segment ACCF,the 3D anatomical titanium cage can achieve similar clinical efficacy and bone fusion rate,can reduce the incidence of cage subsidence effectively,it's clinical use is safe.