颈椎前路椎体次全切除钛网植骨早期塌陷的探讨

目的探讨颈椎前路椎体次全切除减压钛网植骨钢板内固定患者钛网应用优缺点.方法57例脊髓型颈椎病患者,病变累及2个间隙49例,3个间隙5例,采用前路椎体次全切除减压钛网植骨并辅以4种不同带锁钢板内固定,其中Orion钢板25例,Zephir钢板11例,Coddman 10例,CSLP钢板11例.对其疗效及钛网融合情况进行评价.结果57例中51例获6～17月随访,植骨均在12周达到临床愈合,3例患者在术后6周发生钛网下沉,颈椎椎间高度降低,颈椎曲度减小,但术后病人主观感觉满意,3月后复查未见进一步下沉.结论钛网植骨比自体髂骨植骨有优越之处,但有发生下沉的可能.正确处理终板、合适的撑开高度、修剪面进行适当处理以及选择全锁定钢板,以降低下沉发生率.

Discussion of Titanium Mesh Early Subsidence in Anterior Cervical Subtotal Subcorpectomy Patients

Objective: To discuss the advantage and disadv an tage of titanium mesh used in anterior cervical subcorpectomy with locking plate . Method: Fifty-seven cases of cervical spondylosis myelopathy were studied, am ong which 4 9 cases involved two intervertebral discs and 5 cases with three intervertebral discs. All cases were treated with anterior subcorpectomy and implanted with tit anium mesh filled with cancellous bone of resected vertebra body combine with 4 different kinds of anterior plate fixation(Orion 25 cases, Zephir 11 cases, Codd man 10 cases and CSLP 11 cases). The patients' outcome and titanium mesh fusion we re evaluated. Result: Fifty-one of 57 patients were followed up for 10.7 months in avera ge. Solid fusion of the titanium mesh was obtained within 12 weeks. 3 cases had titanium mesh subsidence followed by the lost of intervertebral height and cervi cal lordosis but still had satisfactory self-reception. No further subsidence w as found after 3 months postoperatively. Conclusion: Compared with auto iliac bo ne graft titanium mesh has many advantages, but also has the possibility of subs idence. Correct end plate preparation, ideal distracted height, proper process o f cut face of the mesh and using the firmly locked plate may reduce the incid ence of early stage mesh subsidence.