颈前路椎管减压植骨融合内固定术中应用钛笼与n-HA/PA66人工椎体的疗效比较

目的比较颈椎病颈前路椎管减压植骨融合内固定术中置入钛笼与置入纳米羟基磷灰石/聚酰胺66(nanohydroxyapatite/polyamide66,n-HA/PA66)人工椎体的疗效。方法回顾性分析自2012-01—2017-02采用颈前路椎管减压植骨融合内固定术治疗的97例颈椎病,50例在术中置入钛笼(钛笼组),47例在术中置入n-HA/PA66人工椎体(人工椎体组),比较2组术后即刻、术后3个月、术后6个月颈椎前凸角度与JOA评分,比较2组术后椎体下沉情况以及末次随访时神经功能改善等级。结果97例均顺利完成手术并获得完整随访,随访时间平均10.4(6~18)个月。末次随访时97例均获得骨性融合。2组术后即刻、术后3个月、术后6个月颈椎前凸角度、JOA评分比较差异无统计学意义(P>0.05)。术后6个月钛笼组6例出现钛笼下沉现象,人工椎体组未出现人工椎体下沉现象。人工椎体组椎体下沉情况较钛笼组优,差异有统计学意义(P<0.05)。2组末次随访时神经功能改善等级比较差异无统计学意义(P>0.05)。结论钛笼与n-HA/PA66人工椎体均能有效重建颈椎的稳定性、改善脊髓功能并获得良好的植骨融合率,n-HA/PA66人工椎体置入后可以获得较低的椎体下沉率。

Comparison of the effect on application of titanium cage and n-HA/PA66 artificial vertebral in anterior cervical decompression and fusion surgery

Objective To compare the effect of titanium cage and nano-hydroxyapatite/polyamide 66(n-HA/PA66)artificial vertebral body in cervical anterior cervical spinal decompression and fusion.Methods Ninety seven cases of cervical spondylosis treated with anterior cervical spinal canal decompression and fusion from January 2012 to February 2017 was retrospectively analyzed.Fifty cases were implanted with a titanium cage(titanium cage group)and 47 cases with n-HA/PA66 artificial vertebral body(artificial vertebral body group)during the operation.The cervical lordosis angle and JO A score immediately,3 months and 6 months after surgery,the vertebral body subsidence after surgery and the neurological grade improvement at the last follow-up were compared between the two groups.Results All the 97 cases successfully completed the operation and received complete follow-up.The average follow-up time was 10.4(6-18)months.At the last follow-up,all 97 cases obtained bony fusion.There was no significant difference in cervical lordosis angle and JO A score immediately(P>0.05),3 months and 6 months after operation between the two groups.Six months after the operation,there were 6 cases of titanium cage sinking in the titanium cage group,and no artificial vertebral body sinking in the artificial vertebral body group.The sinking of the vertebral body in the artificial vertebral body group was better than that in the titanium cage group,and the difference was statistically significant(P<0.05).There was no significant difference in the level of neurological improvement between the two groups at the last follow-up(P>0.05).Conclusion Both the titanium cage and the n-HA/PA66 artificial vertebral body can effectively reconstruct the stability of the cervical spine,improve the spinal cord function and obtain a good bone graft fusion rate.The subsidence rate of n-HA/PA66 artificial vertebral is lower.