Schröder J, Grosse-Dresselhaus F, Schul C, Wassmann H
Department of Neurosurgery, University Clinics Muenster, Germany.
Zentralbl Neurochir. 2007 Feb;68(1):2-7. doi: 10.1055/s-2006-942184.
Nonautologous interbody fusion materials are utilised in increasing numbers after anterior cervical disc surgery to overcome the problem of donor site morbidity of autologous bone grafts. This study investigates the performance of two nonautologous materials, the bone cement Polymethylmethacrylate (PMMA) and titanium cages. This prospective randomised trial, with assessment of the results by an independent observer, evaluates whether a Polymethylmethacrylate (PMMA) spacer or a titanium cage provides a better fusion rate around the implant and a better clinical outcome.
PATIENTS/MATERIAL AND METHODS: Between 2000 and 2002, 115 patients with monoradicular cervical nerve root compression syndrome caused by soft cervical disc herniation were eligible for this study. Myelopathy, excessive osteophyte formation, and adjacent level degeneration were exclusion criteria. A block-restricted randomisation was applied. The 2-year clinical outcome served as the primary endpoint of the study. Clinical outcome was assessed according to the Odom scale by an independent observer at the follow-up examination. Preoperative, postoperative, and follow-up radiographs were taken.
The study was completed by 107 patients (53 with PMMA and 54 with titanium cage). No significant difference between the two groups could be established with respect to the clinical outcome. In each group, 26 patients scored excellent. Good results were found in 19 PMMA patients and 16 titanium cage patients; satisfactory results were found in 8 PMMA patients and 9 titanium cage patients; bad results were found in 3 titanium cage patients. In 47 titanium cage cases (87%), fusion occurred radiologically as bony bridging around the implant. The fusion rate was significantly lower (p=0.011) in the PMMA group, with 35 cases (66%) united at follow-up.
The radiological result of the titanium cage is superior to that of PMMA with respect to the fusion rate. Although the titanium cage achieves a better fusion rate, there is no difference between titanium cages and PMMA with respect to the clinical outcome.
在前路颈椎间盘手术后，越来越多地使用非自体椎间融合材料来克服自体骨移植供区发病的问题。本研究调查了两种非自体材料——骨水泥聚甲基丙烯酸甲酯（PMMA）和钛笼的性能。这项前瞻性随机试验由独立观察者评估结果，旨在评估聚甲基丙烯酸甲酯（PMMA）间隔物或钛笼是否能在植入物周围提供更好的融合率和更好的临床结果。
患者/材料与方法：2000年至2002年期间，115例因软性颈椎间盘突出症导致单根颈神经根受压综合征的患者符合本研究条件。脊髓病、过多骨赘形成和相邻节段退变为排除标准。采用区组限制随机化。2年临床结果作为研究的主要终点。在随访检查时，由独立观察者根据奥多姆量表评估临床结果。拍摄术前、术后及随访X线片。
107例患者完成了研究（53例使用PMMA，54例使用钛笼）。两组在临床结果方面未发现显著差异。每组中，26例患者评分优秀。19例使用PMMA的患者和16例使用钛笼的患者结果良好；8例使用PMMA的患者和9例使用钛笼的患者结果满意；3例使用钛笼的患者结果不佳。在47例使用钛笼的病例中（87%），影像学上出现融合，表现为植入物周围的骨桥形成。PMMA组的融合率显著较低（p = 0.011），随访时有35例（66%）融合。
在融合率方面，钛笼的影像学结果优于PMMA。尽管钛笼实现了更好的融合率，但在临床结果方面，钛笼和PMMA之间没有差异。
