颈椎前路椎体次全切钛网融合术后颈椎 CT 值早期降低

Low cervical vertebral CT value increased early subsidence of titanium mesh cage after anterior cervical corpectomy and fusion.

机构信息

Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030032, China.

Department of orthopedics, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China.

出版信息

J Orthop Surg Res. 2022 Jul 16;17(1):355. doi: 10.1186/s13018-022-03239-6.

DOI:10.1186/s13018-022-03239-6

PMID:35842647

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9287865/

Abstract

STUDY DESIGN

This study was a retrospective review.

OBJECTIVE

To study the predictive effect of Hounsfield units (HU) value in the cervical vertebral body derived from computed tomography (CT) on the early titanium mesh cage (TMC) subsidence after anterior cervical corpectomy and fusion (ACCF).

METHODS

This retrospective study was conducted on patients who underwent ACCF at one institution between January 2014 and December 2018. We collected date included age, gender, body mass index (BMI), disease type, surgical segment, whether merge ACDF, HU value of the vertebral body and endplate, vertebral body height loss, cervical lordosis angle, and cervical sagittal alignment. VAS, JOA, and NDI were used to assess clinical efficacy. Univariate analysis was performed to screen the influencing factors of TMC subsidence, and then logistic regression was used to find out the independent risk factors. The ROC curve and area under curve (AUC) were used to analyze the HU value to predict the TMC subsidence.

RESULTS

A total of 85 patients who accepted ACCF were included in this study, and early titanium mesh cage subsidence was demonstrated in 29 patients. The subsidence rate was 34.1%. The JOA, VAS, and NDI scores significantly improved in both groups after the operation. Between the subsidence and non-subsidence groups, there were significant differences in age, intervertebral distraction height, and HU value in both upper and lower vertebral body and endplate. The logistic regression analysis proved that the HU value of the lower vertebral body was an independent risk of TMC subsidence, the AUC was 0.866, and the most appropriate threshold of the HU value was 275 (sensitivity: 87.5%, specificity: 79.3%).

CONCLUSION

Preoperative cervical CT value is an independent correlative factor for early TMC subsidence after ACCF, and patients with a low CT value of the inferior vertebral body of the operative segment have a higher risk of TMC subsidence in the early postoperative period.

TRIAL REGISTRATION

This study is undergoing retrospective registration.

摘要

研究设计

本研究为回顾性研究。

目的

研究颈椎体 CT 横截面积（HU）值对颈椎前路椎体次全切融合术（ACCF）后早期钛网笼（TMC）下沉的预测作用。

方法

本回顾性研究纳入 2014 年 1 月至 2018 年 12 月在一家机构行 ACCF 的患者。收集的日期包括年龄、性别、体重指数（BMI）、疾病类型、手术节段、是否合并前路颈椎间盘切除融合术（ACDF）、椎体和终板 HU 值、椎体高度丢失、颈椎前凸角、颈椎矢状位排列。使用视觉模拟评分（VAS）、日本骨科协会（JOA）评分和颈椎功能障碍指数（NDI）评估临床疗效。单因素分析筛选 TMC 下沉的影响因素，然后进行 logistic 回归分析，找出独立的危险因素。ROC 曲线和曲线下面积（AUC）用于分析 HU 值预测 TMC 下沉的能力。

结果

本研究共纳入 85 例行 ACCF 的患者，其中 29 例出现早期钛网笼下沉，下沉率为 34.1%。两组患者术后 JOA、VAS 和 NDI 评分均明显改善。在下沉组和非下沉组之间，年龄、椎间撑开高度以及上下位椎体和终板的 HU 值存在显著差异。logistic 回归分析证实下位椎体 HU 值是 TMC 下沉的独立危险因素，AUC 为 0.866，最适 HU 值阈值为 275（灵敏度：87.5%，特异性：79.3%）。