Zhang Zhi-Jing, Lu Yi-Sheng, Chen Hong
The Second Department of Orthopaedics, the 117th Hospital of PLA, Hangzhou 310014, Zhejiang, China.
The Second Department of Orthopaedics, the 117th Hospital of PLA, Hangzhou 310014, Zhejiang, China;
Zhongguo Gu Shang. 2018 Jan 25;31(1):5-11. doi: 10.3969/j.issn.1003-0034.2018.01.002.
To compare radiographic results and clinical effects of titanium mesh cage with two endcaps(on-endcaps titanium mesh cage) and without endcaps(non-endcaps titanium mesh cage) in anterior cervical corpectomy and fusion(ACCF) for elderly cervical spondylotic myelopathy.
The clinical data of 60 patients with cervical spondylotic myelopathy underwent ACCF from January 2011 to January 2016 were retrospectively analyzed. There were 26 males and 34 females, aged from 68 to 79 years old with a mean 75.8 years old. The patients were divided into two groups according to the different titanium mesh cage, using on-endcaps titanium mesh cage(group A, 32 cases) or non-endcaps titanium mesh cage (group B, 28 cases). The nerve function was evaluated by JOA score system; the height of intervertebral fusion segments and fusion segmental lordosis angle (Cobb angle) were measured by cervical lateral X-ray films, the bone graft fusion rate of titanium mesh was evaluated by CT.
All the patients were followed up from 1 to 2 years with an average of 1.5 years. The preoperative JOA scores of group A were 9.3±1.7, postoperative at 1 week, 3 months, 1 year were 14.2±1.8, 15.7±1.2, 15.4±1.5, respectively; and the preoperative JOA scores of group B were 9.1±1.8, postoperative at 1 week, 3 months, 1 year were 14.5±1.3, 14.9±1.7, 15.2±1.6, respectively. The postoperative JOA scores between two groups were obviously improved than that of preoperative (<0.05). There was no significant difference in JOA scores of 3 time-point after operation between two groups (>0.05). In the group A, preoperative intervertebral height were(42.1±2.4) mm, postoperative at 1 week, 3 months, 1 year were (45.3±3.2) mm, (44.7±2.9) mm, (44.5±3.0) mm, respectively; preoperative Cobb angle of fusion segments were (5.3±1.2)°, postoperative at 1 week, 3 months, 1 year were (10.3±1.9) °, (10.1±1.7) °, (9.9±1.3) °, respectively. And in group B, preoperative intervertebral height were (43.4±2.3)mm, postoperative at 1 week, 3 months, 1 year were (45.7±2.8) mm, (44.2±2.7) mm, (41.5±2.1) mm, respectively; preoperative Cobb angle of fusion segments were (5.4±1.0) °, postoperative at 1 week, 3 months, 1 year were (11.2±1.8)°, (10.8±1.6)°, (7.2±1.4) °, respectively. The postoperative intervertebral height, Cobb angle of fusion segments between two groups were obviously improved than that of preoperative (<0.05). There was no significant difference in intervertebral height and Cobb angle at 1 week, 3 months after operation between two groups(>0.05). One year after operation, intervertebral height and Cobb angle in group A was better than that of group B(<0.05).
On-endcaps titanium mesh cage is superior to non-endcaps titanium mesh cage in the maintenance of cervical intervebral height and segmental lordosis angle postoperatively at elderly spondylotic myelopathy complicated with osteoporosis. The usage of on-endcaps titanium mesh cage can effectively reduce postoperative subsidence rate.
比较带两端盖钛网笼（端盖式钛网笼）和不带两端盖钛网笼（非端盖式钛网笼）在老年脊髓型颈椎病前路椎体次全切除融合术（ACCF）中的影像学结果和临床效果。
回顾性分析2011年1月至2016年1月行ACCF的60例脊髓型颈椎病患者的临床资料。其中男性26例，女性34例，年龄68～79岁，平均75.8岁。根据所用钛网笼不同将患者分为两组，使用端盖式钛网笼的为A组（32例），使用非端盖式钛网笼的为B组（28例）。采用JOA评分系统评估神经功能；通过颈椎侧位X线片测量椎间融合节段高度和融合节段前凸角（Cobb角），采用CT评估钛网植骨融合率。
所有患者均随访1～2年，平均1.5年。A组术前JOA评分为9.3±1.7，术后1周、3个月、1年分别为14.2±1.8、15.7±1.2、15.4±1.5；B组术前JOA评分为9.1±1.8，术后1周、3个月、1年分别为14.5±1.3、14.9±1.7、15.2±1.6。两组术后JOA评分均较术前明显改善（<0.05）。两组术后3个时间点的JOA评分比较差异无统计学意义（>0.05）。A组术前椎间高度为（42.1±2.4）mm，术后1周、3个月、1年分别为（45.3±3.2）mm、（44.7±2.9）mm、（44.5±3.0）mm；术前融合节段Cobb角为（5.3±1.2）°，术后1周、3个月、1年分别为（10.3±1.9）°、（10.1±1.7）°、（9.9±1.3）°。B组术前椎间高度为（43.4±2.3）mm，术后1周、3个月、1年分别为（45.7±2.8）mm、（44.2±2.7）mm、（41.5±2.1）mm；术前融合节段Cobb角为（5.4±1.0）°，术后1周、3个月、1年分别为（11.2±1.8）°、（10.8±1.6）°、（7.2±1.4）°。两组术后椎间高度、融合节段Cobb角均较术前明显改善（<0.05）。两组术后1周、3个月时椎间高度和Cobb角比较差异无统计学意义（>0.05）。术后1年，A组椎间高度和Cobb角优于B组（<0.05）。
在老年脊髓型颈椎病合并骨质疏松患者中，端盖式钛网笼在维持术后颈椎椎间高度和节段前凸角方面优于非端盖式钛网笼。使用端盖式钛网笼可有效降低术后下沉率。
