Vaccaro A R, Falatyn S P, Scuderi G J, Eismont F J, McGuire R A, Singh K, Garfin S R
Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.
J Spinal Disord. 1998 Oct;11(5):410-5.
A retrospective, multicenter study was undertaken to evaluate the early postoperative failure rate of long segment anterior cervical fusion and plating to stabilize the cervical spine after a two- or three-level corpectomy for degenerative, traumatic, and neoplastic diseases of the cervical spine. Patient demographic factors as well as technical factors such as bone graft placement, plate and screw position, and postoperative brace immobilization were analyzed. During the early postoperative period, the graft/plate construct dislodged in 3 of 33 patients with a two-level corpectomy and fusion (9%) compared with 6 of 12 patients with a three-level corpectomy and fusion (50%). The difference in failure rates after a three- versus two-level corpectomy and fusion was statistically significant (p < 0.05). A higher early failure rate was also seen with failure to correctly lock the screws to the plate and the use of a peg-in-hole type bone grafting technique, although these differences were not statistically significant. Although several technical and patient-specific factors may contribute to this, anterior cervical plating and bone grafting alone after a three-level cervical corpectomy for various spinal disorders appears to afford inadequate stability in the early postoperative period, regardless of immobilization methods.
进行了一项回顾性多中心研究，以评估在因颈椎退行性、创伤性和肿瘤性疾病行两节或三节椎体次全切除术后，采用长节段颈椎前路融合及钢板固定来稳定颈椎的术后早期失败率。分析了患者人口统计学因素以及诸如植骨位置、钢板和螺钉位置及术后支具固定等技术因素。术后早期，在33例行两节椎体次全切除及融合的患者中，有3例（9%）出现植骨/钢板结构移位，而在12例行三节椎体次全切除及融合的患者中，有6例（50%）出现移位。三节与两节椎体次全切除及融合后的失败率差异具有统计学意义（p<0.05）。螺钉未正确锁定至钢板以及使用钉孔型植骨技术时，早期失败率也较高，尽管这些差异无统计学意义。尽管可能有多种技术和患者特异性因素导致这种情况，但对于各种脊柱疾病，在三节颈椎椎体次全切除术后单纯采用颈椎前路钢板固定和植骨，无论固定方法如何，在术后早期似乎都提供了不足的稳定性。
