Chuang Hao-Che, Cho Der-Yang, Chang Cheng-Siu, Lee Wen-Yuen, Jung-Chung Chen, Lee Han-Chung, Chen Chun-Chung
Department of Neurosurgery, China Medical University Hospital, Taichung, Taiwan 404, Republic of China.
Surg Neurol. 2006 May;65(5):464-71; discussion 471. doi: 10.1016/j.surneu.2005.12.021.
To determine the safety and effectiveness of the use of titanium mesh cages (TMCs) and anterior cervical plates (ACPs) for interbody fusion after anterior cervical corpectomy.
From June 2001 to June 2003, 15 patients underwent reconstruction with TMCs and ACPs for interbody fusion after anterior cervical corpectomy in our hospital. The mean follow-up is 13.6 months (range, 9-24 months). Subjects included those with cervical degenerative, traumatic, or pathological diseases. Titanium mesh cages were filled with autologous bone grafts taken from the corpectomy and iliac crest bone chips and were all filled with triosite (calcium phosphate ceramics). The patients' observable signs, neurological reconstruction results, and complications were fully and explicitly recorded throughout the procedure. Radiological imaging studies for measurements of coronal and sagittal angles, sagittal displacements, and settling ratio changes were performed to evaluate spinal stability. We used axial cervical computed tomography (CT) and reconstructive sagittal cervical CT to demonstrate interbody fusion within titanium mesh.
The alleviation and frequent disappearance of the subjects' original symptoms and the significant neurological recovery obvious in most patients indicated that postoperative spinal stability could be well maintained. No significant differences in mean cage height-related settling rates, mean sagittal displacements, and mean coronal and sagittal angle changes were observed between 1-level and multilevel corpectomy. All patients who received axial and reconstructive sagittal cervical CT scan could demonstrate true interbody fusion within TMC, and no nonunions were present. Cage malplacement was observed in one subject who had neck pain and neck stiffness, rather than from radiculopathy or myelopathy. One subject died of acute myocardial infarction. There were no ceramic-related complications.
Based on preliminary findings from this study, reconstruction involving TMC interbody fusion with ACP fixation after anterior cervical corpectomy serves as an effective and safe method for the treatment of cervical disease.
确定在颈椎椎体次全切除术后使用钛网笼（TMC）和颈椎前路钢板（ACP）进行椎间融合的安全性和有效性。
2001年6月至2003年6月，我院15例患者在颈椎椎体次全切除术后接受了TMC和ACP重建以进行椎间融合。平均随访时间为13.6个月（范围9 - 24个月）。受试者包括患有颈椎退行性、创伤性或病理性疾病的患者。钛网笼填充有取自椎体次全切除部位的自体骨移植骨和髂嵴骨屑，并且均填充有磷酸三钙陶瓷。在整个过程中全面且明确地记录患者的可观察体征、神经功能重建结果及并发症。进行放射学成像研究以测量冠状面和矢状面角度、矢状面移位及沉降率变化，以评估脊柱稳定性。我们使用颈椎轴向计算机断层扫描（CT）和颈椎矢状面重建CT来显示钛网内的椎间融合情况。
受试者原有症状的缓解及频繁消失，且大多数患者神经功能明显恢复，表明术后脊柱稳定性可得到良好维持。单节段和多节段椎体次全切除术之间在平均笼高相关沉降率、平均矢状面移位以及平均冠状面和矢状面角度变化方面未观察到显著差异。所有接受颈椎轴向和矢状面重建CT扫描的患者均显示TMC内真正的椎间融合，且无骨不连情况。1例出现颈部疼痛和颈部僵硬而非神经根病或脊髓病的患者观察到笼移位。1例患者死于急性心肌梗死。未出现与陶瓷相关的并发症。
基于本研究的初步结果，颈椎椎体次全切除术后采用TMC椎间融合并结合ACP固定的重建术是治疗颈椎疾病的一种有效且安全的方法。
