Hirai Takashi, Yoshii Toshitaka, Sakai Kenichiro, Inose Hiroyuki, Yuasa Masato, Yamada Tsuyoshi, Matsukura Yu, Ushio Shuta, Morishita Shingo, Egawa Satoru, Onuma Hiroaki, Kobayashi Yutaka, Utagawa Kurando, Hashimoto Jun, Kawabata Atsuyuki, Tanaka Tomoyuki, Motoyoshi Takayuki, Takahashi Takuya, Hashimoto Motonori, Sakaeda Kentaro, Kato Tsuyoshi, Arai Yoshiyasu, Kawabata Shigenori, Okawa Atsushi
Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan.
Department of Orthopedic Surgery, Saitamaken-Saiseikai Kawaguchi General Hospital, 5-11-5 Nishikawaguchu, Kawaguchi City 332-8558, Japan.
J Clin Med. 2021 Nov 15;10(22):5315. doi: 10.3390/jcm10225315.
Various studies have found a high incidence of early graft dislodgement after multilevel corpectomy. Although a hybrid fusion technique was developed to resolve implant failure, the hybrid and conventional techniques have not been clearly compared in terms of perioperative complications in patients with severe ossification of the posterior longitudinal ligament (OPLL) involving three or more levels. The purpose of this study was to compare clinical and radiologic outcomes between anterior cervical corpectomy with fusion (ACCF) and anterior hybrid fusion for the treatment of multilevel cervical OPLL. We therefore retrospectively reviewed the clinical and radiologic data of 53 consecutive patients who underwent anterior fusion to treat cervical OPLL: 30 underwent ACCF and 23 underwent anterior hybrid fusion. All patients completed 2 years of follow-ups. Implant migration was defined as subsidence > 3 mm. There were no significant differences in demographics or clinical characteristics between the ACCF and hybrid groups. Early implant failure occurred significantly more frequently in the ACCF group (5 cases, 16.7%) compared with the hybrid group (0 cases, 0%). The fusion rate was 80% in the ACCF group and 100% in the hybrid group. Although both procedures can achieve satisfactory neurologic outcomes for multilevel OPLL patients, hybrid fusion likely provides better biomechanical stability than the conventional ACCF technique.
多项研究发现，多节段椎体次全切除术后早期移植物脱位的发生率较高。尽管已开发出一种混合融合技术来解决植入物失败的问题，但在涉及三个或更多节段的严重后纵韧带骨化（OPLL）患者的围手术期并发症方面，混合技术与传统技术尚未得到明确比较。本研究的目的是比较颈椎前路椎体次全切除融合术（ACCF）和前路混合融合术治疗多节段颈椎OPLL的临床和影像学结果。因此，我们回顾性分析了53例连续接受前路融合术治疗颈椎OPLL患者的临床和影像学资料：30例行ACCF，23例行前路混合融合术。所有患者均完成了2年的随访。植入物移位定义为下沉>3mm。ACCF组和混合组在人口统计学或临床特征方面无显著差异。与混合组（0例，0%）相比，ACCF组早期植入物失败的发生率显著更高（5例，16.7%）。ACCF组的融合率为80%，混合组为100%。尽管两种手术方法都能为多节段OPLL患者带来满意的神经学结果，但混合融合术可能比传统的ACCF技术提供更好的生物力学稳定性。
