摘要
[目的]比较钛网与自体髂骨在脊髓型颈椎病前路椎体次全切手术中植骨融合、重建颈椎稳定性和经济支出的差异。[方法]回顾性研究2009年1月~2011年12月86例行前路减压融合术的脊髓型颈椎病患者资料,均为单节段或双节段患者。其中49例采用钛网植骨内固定,男31例,女18例;年龄39~71岁,平均49.8岁;另外37例采用自体髂骨植骨内固定,男23例,女14例;年龄36~64岁,平均51.3岁。[结果]两组患者颈部切口和髂骨组患者取骨区切口均I期愈合,两组患者均无术中并发症,术后无脑脊液漏以及伤口感染。随访时间28~39个月,平均33.6个月。髂骨组手术时间长于钛网组（P〈0.05）,而住院费用低于钛网组（P〈0.05）。所有患者均于6~9个月获得骨性融合,两组间差异无统计学意义（P〉0.05）。术后JOA评分两组在各随访时间点差异均无统计学意义（P〉0.05）。术后3个月开始Cobb角相对于术后即刻的改变髂骨组较钛网组明显（P〈0.05）;术后9个月之后的融合节段前缘高度（HAB）值相对于术后即刻改变两组间有差异（P〈0.05）,髂骨组变化较大。[结论]颈前路椎体次全切除术治疗脊髓型颈椎病,无论采用钛网还是自体髂骨植骨均可获得较好的治疗效果,前者经济支出较高,但其在维持融合节段椎体高度以及颈椎曲度方面具有优势。
[ Objective] To compare the differences in fusion, rebuilding of stability and cost between the iliac bone auto- graft and the titanium mesh in anterior cervical corpectomy fusion. [ Methods] A retrospective study was performed on 86 cervi- cal spondylotic myelopathy patients who underwent anterior cervical decompression and fusion, 49 with titanium mesh and 37 with iliac bone autograft. The iliac autograft group consisted of 31 male and 18 female, with average age of 49. 8 years （range, 39 ~ 71 years） . The titanium mesh group was composed of 23 male and 14 female, with average age of 51. 3 years （range, 36 - 64 years） . No statistic difference was found between two groups in terms of gender, age, duration of disease, involved seg- ments, Cobbg angle, JOA score, et al. While other differences between groups were investigated, including operation time, loss of blood in operation, and cost of hospitalization. Preoperative, immediate - postoperative and 3, 6, 9, 12 months postoperative follow - up radiographs were taken to observe the change of Cobb angle and the height of vertebral fusion （HAB） . JOA scores were also compared between the two groups. [Results] All patients in the both groups got excellent wound healing. Fusion was achieved in both groups during the 6 -9 months follow -up. The operation time in the iliac bone autograft group was longer, but the cost was lower （ P 〈 0.05 ） . The Cobb angle changed more significantly in the iliac bone autograft group than in the titanium mesh group from the 3rd month postoperatively （ P 〈 0. 05 ）, while the HAB changed more significantly as well from the 9th month postoperatively （P 〈 0. 05） . There was no difference in JOA scores between the iliac group and the titanium mesh group （P 〉 0. 05） . [ Conclusion] Both autograft surgery and titanium mesh implantation could gain good decompression and fusion in anterior cervical corpectomy fusion for spondylotic myelopathy. The titanium meshes have advantages in maintaining the height of
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2015年第23期2123-2127,共5页
Orthopedic Journal of China
关键词
颈椎病
钛网
自体髂骨
植骨融合
cervical spondylotic myelopathy, titanium mesh, iliac bone autograft, fusion
