Li Jing, Zhang Junqi, Wang Beiyu, Huang Kangkang, Yang Xi, Song Yueming, Liu Hao, Rong Xin
Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China.
Spine (Phila Pa 1976). 2025 Jan 15;50(2):88-95. doi: 10.1097/BRS.0000000000005126. Epub 2024 Aug 23.
A prospective nonrandomized controlled study.
To compare the clinical and radiographic outcomes of anterior cervical corpectomy and fusion (ACCF) using titanium mesh cages (TMCs), nano-hydroxyapatite/polyamide 66 (n-HA/PA66) cages, and three-dimensional-printed vertebral bodies (3d-VBs).
Postoperative subsidence of TMCs in ACCF has been widely reported. Newer implants such as n-HA/PA66 cages and 3d-VBs using biocompatible titanium alloy powder (Ti6Al4V) have been introduced to address this issue, but their outcomes remain controversial.
We enrolled 60 patients undergoing ACCF using TMCs, n-HA/PA66 cages, or 3d-VBs from January 2020 to November 2021. For each group, there were 20 patients. Follow-up was conducted for a minimum of 2 years. Clinical outcomes, including Japanese Orthopedic Association (JOA) scores, Neck Disability Index, and Visual Analog Scale scores, and radiographic outcomes, including function of spinal unit (FSU) height, fusion rate, and cervical alignment, were collected preoperatively and at each follow-up. A loss of FSU height ≥3mm was deemed implant subsidence. One-way analysis of variance was used for comparisons of mean values at different time points within the same group, with pairwise comparisons performed using the least significance difference method. The Mann-Whitney test was used for comparisons between groups. Categorical data such as sex, smoking status, implant subsidence, and pathology level were analyzed using the χ 2 test.
Postoperative FSU height loss at 2 years differed significantly among the TMC, n-HA/PA66, and 3d-VB groups, measuring 3.07 ± 1.25mm, 2.11 ± 0.73mm, and 1.46 ± 0.71mm, respectively ( P < 0.001). The rates of implant subsidence were 45%, 20%, and 10%, respectively ( P = 0.031). All patients obtained solid fusion at a 2-year follow-up. We observed statistically significant differences in Visual Analog Scale and JOA scores at 3 months postoperatively, and JOA scores at 2 years postoperatively among the 3 groups. At a 2-year follow-up, the n-HA/PA66 and the 3d-VBs groups exhibited less FSU height loss, lower subsidence rates, and demonstrated better cervical lordosis than the TMC group. No severe postoperative complications were observed in any of the patients, and no patient required reoperation.
At a 2-year follow-up after ACCF, the n-HA/PA66 and the 3d-VBs groups exhibited less FSU height loss, lower subsidence rates, and demonstrated better cervical lordosis than the TMC group. Longer-term observation of implant subsidence in ACCF using TMC, n-HA/PA66, and 3d-VB is necessary.
Level III-therapeutic.
前瞻性非随机对照研究。
比较使用钛网笼（TMC）、纳米羟基磷灰石/聚酰胺66（n-HA/PA66）笼和三维打印椎体（3d-VB）进行颈椎前路椎体次全切除融合术（ACCF）的临床和影像学结果。
ACCF中TMC术后下沉的情况已被广泛报道。已引入新型植入物，如n-HA/PA66笼和使用生物相容性钛合金粉末（Ti6Al4V）的3d-VB来解决这一问题，但其结果仍存在争议。
我们纳入了2020年1月至2021年11月期间接受ACCF手术，使用TMC、n-HA/PA66笼或3d-VB的60例患者。每组20例患者。随访至少2年。术前及每次随访时收集临床结果，包括日本骨科协会（JOA）评分、颈部残疾指数和视觉模拟量表评分，以及影像学结果，包括脊柱单元（FSU）高度、融合率和颈椎排列情况。FSU高度丢失≥3mm被视为植入物下沉。采用单因素方差分析比较同一组内不同时间点的平均值，并使用最小显著差异法进行两两比较。采用Mann-Whitney检验进行组间比较。使用χ²检验分析性别、吸烟状况、植入物下沉和病变节段等分类数据。
TMC组、n-HA/PA66组和3d-VB组术后2年FSU高度丢失差异显著，分别为3.07±1.25mm、2.11±0.73mm和1.46±0.71mm（P<0.001）。植入物下沉率分别为45%、20%和10%（P = 0.031）。所有患者在2年随访时均获得了牢固融合。我们观察到3组术后3个月的视觉模拟量表和JOA评分以及术后2年的JOA评分存在统计学显著差异。在2年随访时，n-HA/PA66组和3d-VB组的FSU高度丢失更少，下沉率更低，颈椎前凸比TMC组更好。所有患者均未观察到严重术后并发症，也没有患者需要再次手术。
在ACCF术后2年随访时，n-HA/PA66组和3d-VB组的FSU高度丢失更少，下沉率更低，颈椎前凸比TMC组更好。有必要对使用TMC、n-HA/PA66和3d-VB进行ACCF的植入物下沉情况进行长期观察。
三级治疗性。
