【摘要】：背景:目前在臨床上針對(duì)頸椎退變、創(chuàng)傷、腫瘤等多種疾病,頸前路椎體次全切除術(shù)被廣泛應(yīng)用。該手術(shù)的關(guān)鍵點(diǎn)是手術(shù)中切除椎管前方壓迫,充分減壓以及減壓后頸椎植骨融合保證頸椎穩(wěn)定性。通過(guò)手術(shù)實(shí)現(xiàn)脊髓減壓,并酌情選擇不同的融合技術(shù),恢復(fù)維持頸椎的穩(wěn)定性。手術(shù)減壓完成后,鈦網(wǎng)的原位植骨不但可以避免了供骨區(qū)并發(fā)癥而且獲得了較高的植骨融合率,因此在臨床上被越來(lái)越多的人使用。然而,術(shù)后頸椎鈦網(wǎng)沉降可致使頸椎生理曲度改變及椎間高度的丟失,可能造成術(shù)后患者出現(xiàn)神經(jīng)功能損傷,甚至出現(xiàn)頸椎后突畸形,融合失敗等并發(fā)癥,甚至需要翻修手術(shù)。因此,本文對(duì)鈦網(wǎng)沉降的相關(guān)因素進(jìn)行研究并探討其與臨床效果的聯(lián)系,以降低頸椎鈦網(wǎng)沉降的發(fā)生率。目的:通過(guò)本課題的研究,探討頸前路椎體次全切鈦網(wǎng)植骨融合術(shù)后鈦網(wǎng)發(fā)生沉降的相關(guān)因素及其對(duì)臨床療效的影響,并提出相應(yīng)改善對(duì)策。方法:回顧性分析在2006年10月至2016年10月十年間,在我院收治的81例行頸前路椎體次全切鈦網(wǎng)植骨融合術(shù)的患者臨床資料與影像學(xué)資料。根據(jù)鈦網(wǎng)是否發(fā)生沉降,將患者分為沉降組與非沉降組,觀察分析鈦網(wǎng)沉降與患者年齡、性別、撐開(kāi)角度、鈦網(wǎng)植入位置等相關(guān)因素的關(guān)系。并研究鈦網(wǎng)沉降對(duì)術(shù)后神經(jīng)功能恢復(fù)的影響。結(jié)果:完成隨訪(fǎng)的81例患者中,有24例(29.6%)患者術(shù)后出現(xiàn)鈦網(wǎng)沉降。研究發(fā)現(xiàn)鈦網(wǎng)沉降的相關(guān)因素中,兩組在年齡方面的比較,差異有統(tǒng)計(jì)學(xué)意義。而在性別、手術(shù)節(jié)段、術(shù)前JOA評(píng)分這幾個(gè)方面的差別無(wú)統(tǒng)計(jì)學(xué)意義。撐開(kāi)角度30°者共46例,沉降組7例(15.9%),撐開(kāi)角度≥30°者共35例,沉降組17例(48.6%)。椎體前緣與鈦網(wǎng)前緣間距小于lmm者共45例,沉降組9例(20%),椎體前緣與鈦網(wǎng)前緣間距≥1mm者共36例,下沉15例(41.7%)。兩組在撐開(kāi)角度和鈦網(wǎng)植入位置兩個(gè)相關(guān)因素的比較,差異存在統(tǒng)計(jì)學(xué)意義。通過(guò)分析患者術(shù)后的神經(jīng)功能改善率,發(fā)現(xiàn)沉降組與非沉降組差異無(wú)統(tǒng)計(jì)學(xué)意義。結(jié)論:鈦網(wǎng)沉降的因素可能包括年齡、椎間撐開(kāi)角度和鈦網(wǎng)植入位置。頸椎前路單節(jié)段椎體次全切鈦網(wǎng)植骨融合術(shù)后,發(fā)生鈦網(wǎng)沉降對(duì)手術(shù)效果的影響無(wú)統(tǒng)計(jì)學(xué)意義。掌握好恰當(dāng)?shù)氖中g(shù)適應(yīng)證,正確處理椎體終板,進(jìn)行適當(dāng)?shù)膿伍_(kāi)角度,選用合適的鈦板,選擇合適的鈦網(wǎng)并進(jìn)行正確修剪,正確的鈦網(wǎng)植入位置等可以在一定程度上預(yù)防或減輕術(shù)后鈦網(wǎng)沉降的發(fā)生。
[Abstract]:Background: at present, anterior cervical subtotal vertebra resection is widely used for cervical degeneration, trauma, tumor and other diseases. The key point of the operation is to remove the anterior compression of the spinal canal, decompress fully and ensure the stability of the cervical spine after decompression. Spinal cord decompression was achieved by surgery, and different fusion techniques were selected to restore the stability of cervical spine. After decompression, titanium mesh bone graft in situ can not only avoid the complications of donor bone area, but also obtain a high fusion rate, so it has been used by more and more people in clinic. However, the postoperative titanium mesh subsidence can cause the cervical spine physiological curvature change and the loss of intervertebral height, which may result in postoperative patients with neurological damage, even cervical posterior process malformation, fusion failure and other complications, or even need revision surgery. Therefore, this paper studies the related factors of titanium mesh sedimentation and discusses its relationship with clinical effect in order to reduce the incidence of cervical titanium mesh subsidence. Objective: through the study of this subject, to explore the related factors of titanium mesh subsidence after anterior cervical approach subtotal titanium mesh fusion and its influence on clinical curative effect, and to put forward the corresponding improvement countermeasures. Methods: the clinical data and imaging data of 81 cases of anterior cervical vertebra subtotal titanium mesh grafting and fusion between October 2006 and October 2016 were retrospectively analyzed. The patients were divided into two groups according to whether the titanium mesh subsidence occurred. The relationship between the sedimentation of titanium mesh and the patient's age, sex, angle of distraction, placement position of titanium mesh was observed and analyzed. The effect of titanium mesh sedimentation on the recovery of nerve function after operation was studied. Results: among 81 patients, 24 (29.6%) had postoperative titanium mesh deposition. It was found that there were significant differences in age between the two groups among the relative factors of titanium mesh subsidence. There was no significant difference in gender, operative segment and preoperative JOA score. There were 46 cases with 30 擄distraction angle, 7 cases (15.9%) in the subsidence group, 35 cases (鈮，

本文編號(hào)：2148145