摘要
背景:椎间植入物下沉是颈前路减压融合术后的常见并发症之一,了解该并发症具有重要意义。目的:总结关于颈前路减压融合术后椎间植入物下沉的国内外文献,以期对脊柱外科医生进行临床指导。方法:在中国知网、万方数据库和PubMed数据库,以“intervertebral implant,subsidence,anterior cervical decompression and fusion,cage,review,biomechanical analysis,three-dimensional finite element,three-dimensional printing technology,complications,biomaterials”及“椎间植入物,下沉,颈前路减压融合术,融合器,综述,生物力学研究,三维有限元,3D打印技术,并发症,生物材料”为检索词进行文献检索。结果与结论:(1)在术前因素中,骨质疏松、体质量指数较低、更高的T1倾斜率和倒置的颈椎角是颈前路术后出现椎间融合器下沉的危险因素。(2)C6/7是颈前路术后椎间融合器下沉的好发节段,长节段的发生率高于短节段,大多数文献认为,钛板-融合器内固定系统能有效降低下沉风险。(3)植入物的宽度、直径、高度与术后下沉率相关,植入物放置趋于终板中央时下沉风险增高。(4)矩形、解剖型、12-叶形、多孔结构融合器及仿生凹坑表面置于融合器侧面时可有效降低下沉风险。(5)聚醚醚酮材料融合器较钛合金融合器的下沉风险较低,可降解材料、复合材料在近年得到更多的研究,但仍需进一步证明其安全性和有效性。(6)过度刮除终板、椎间过度撑开、颈椎牵开器撑开时间过久、螺钉置入位置较差、植入物置入角度欠佳是导致术后椎间植入物下沉的危险因素,术后过早去除颈托会增加下沉风险。(7)生物力学研究、材料学研究、3D打印技术、远期随访是未来研究颈前路减压融合术后椎间植入物下沉的有效途径。
BACKGROUND: Intervertebral implant subsidence is one of the common complications after anterior cervical decompression and fusion, and it is important to understand this complication.OBJECTIVE: To summarize the domestic and foreign articles on the subsidence of intervertebral implants after anterior cervical decompression and fusion in order to provide clinical guidance for spine surgeons.METHODS: A computed-based online retrieval of CNKI, Wanfang and PubMed databases was conducted with Chinese and English keywords of “intervertebral implant, subsidence, anterior cervical decompression and fusion, cage, review, biomechanical analysis, three-dimensional finite element, three-dimensional printing technology, complications, biomaterials”.RESULTS AND CONCLUSION:(1) Among the preoperative factors, osteoporosis, lower body mass index, higher T1 slope and inverted cervical spine angle were the risk factors for cage subsidence after anterior cervical approach.(2) C6/7 is the most common segment for the subsidence of the interbody cage after anterior cervical approach. The incidence of long segments is higher than that of short segments. Most articles believe that titanium plate-cage internal fixation system can effectively reduce the subsidence risk.(3) The width, diameter and height of the implant are related to the postoperative subsidence rate and the risk of subsidence increases when the implant is placed in the center of the endplate.(4) Rectangular, anatomical, 12-lobed, porous structure cage and bionic pit surface can effectively reduce the risk of subsidence when placed on the side of the cage.(5) Compared with titanium alloy cages, polyether ether ketone cages have lower subsidence risk. Degradable materials and composite materials have been studied more in recent years, but their safety and effectiveness still need to be further proved.(6) Excessive curettage of the endplate, excessive distraction of the intervertebral body, prolonged distraction of the cervical retractor, poor screw placement, and poor imp
作者
彭建城
姚晓玲
凌海乾
赖盈
李捷
Peng Jiancheng;Yao Xiaoling;Ling Haiqian;Lai Ying;Li Jie(Shenzhen Longgang District Orthopedic Hospital,Shenzhen 518116,Guangdong Province,China;School of Clinical Medicine,Guangdong Pharmaceutical University,Guangzhou 510006,Guangdong Province,China)
出处
《中国组织工程研究》
CAS
北大核心
2023年第27期4408-4413,共6页
Chinese Journal of Tissue Engineering Research
关键词
椎间植入物
下沉
颈前路减压融合术
融合器
综述
intervertebral implant
subsidence
anterior cervical decompression and fusion
cage
review
