【摘要】：目的比較鈦網(wǎng)與納米羥基磷灰石/聚酰胺66(n-HA/PA66)頸椎支撐體植骨在頸椎椎體次全切、減壓融合、前路鈦板螺釘系統(tǒng)內(nèi)固定術(shù)后,恢復(fù)維持頸椎曲度、椎間高度及融合率、沉降率的差異。方法 75例確診為兩個(gè)相鄰節(jié)段脊髓型頸椎病的患者行頸椎前路減壓融合術(shù),40例行鈦網(wǎng)支撐體植骨,35例行n-HA/PA66頸椎支撐體植骨,均行椎前釘板系統(tǒng)內(nèi)固定。比較兩組手術(shù)時(shí)間、術(shù)中出血量、住院時(shí)間、JOA評(píng)分、頸椎曲度變化、融合節(jié)段椎間高度及植骨融合情況。分別攝術(shù)前、術(shù)后即刻、術(shù)后3、6、9個(gè)月頸椎標(biāo)準(zhǔn)側(cè)位X線片,測(cè)量融合節(jié)段Cobb角、C2~7Cobb角、D值評(píng)價(jià)頸椎的曲度,同時(shí)測(cè)量融合節(jié)段椎體前緣高度(HAB)、后緣高度(HPB)評(píng)價(jià)支撐體融合沉降情況,對(duì)各參數(shù)不同時(shí)期間差值分別行組間配對(duì)t檢驗(yàn)。結(jié)果所有患者均獲得隨訪,隨訪時(shí)間9~24個(gè)月(平均16.7個(gè)月)。兩組患者術(shù)后的JOA評(píng)分明顯高于術(shù)前,兩組間JOA評(píng)分比較差異無統(tǒng)計(jì)學(xué)意義(P0.05)。兩組患者術(shù)后即刻與術(shù)前D值差值有統(tǒng)計(jì)學(xué)意義(P0.05),在術(shù)后3、6、9個(gè)月融合節(jié)段前后高上差異有統(tǒng)計(jì)學(xué)意義(P0.05),融合率上差異無統(tǒng)計(jì)學(xué)意義(P0.05),而在術(shù)后6、9個(gè)月沉降率上差異有統(tǒng)計(jì)學(xué)意義(P0.05),鈦網(wǎng)組明顯存在早期沉陷,影響融合節(jié)段椎間高度。結(jié)論 n-HA/PA66頸椎支撐體相對(duì)于鈦網(wǎng)支撐植骨具有提高融合率、并發(fā)癥少等優(yōu)點(diǎn),可以有效保持頸椎生理曲度及椎間高度,是一種較為理想的支撐體植骨材料。
[Abstract]:Objective to compare titanium mesh with nano-hydroxyapatite / polyamide 66 (n-HA/PA66) bone graft in subtotal cervical vertebra, decompression and fusion, and restore cervical curvature, intervertebral height and fusion rate after anterior titanium plate screw system fixation. The difference of settlement rate. Methods Seventy-five patients with two adjacent cervical Spondylotic myelopathy underwent anterior cervical decompression and fusion. 40 patients were treated with titanium mesh support bone graft and 35 patients with n-HA/PA66 cervical spine support bone graft. All patients were treated with anterior screw plate system internal fixation. The operation time, intraoperative bleeding volume, hospitalization time and JOA score, cervical curvature, intervertebral height of fusion segment and bone graft fusion were compared between the two groups. Standard lateral radiographs of cervical vertebrae were taken before, immediately after, 3 and 9 months after operation respectively, and the cervical curvature was evaluated by measuring the D value of the fusion segment Cobb angle C2 + 7 Cobb angle. At the same time, the fusion settlement of the support was evaluated by measuring the anterior height of the fusion segment, the height of the posterior edge of (HAB), and the height of the posterior edge. The difference between different stages of the parameters was tested by paired t test. Results all patients were followed up for 924 months (mean 16.7 months). The JOA scores of the two groups were significantly higher than those of the preoperative ones, and there was no significant difference in the JOA scores between the two groups (P0.05). The difference of D value between the two groups immediately after operation was statistically significant (P0.05). There was a significant difference in the height of fusion segment before and after 6 and 9 months after operation (P0.05), but there was no significant difference in fusion rate (P0.05), but in 69 months after operation, the sedimentation rate was lower (P0.05). The difference was statistically significant (P0.05). There were obvious early subsidence in titanium mesh group. Affect fusion level intervertebral height. Conclusion compared with titanium mesh support, n-HA/PA66 has the advantages of high fusion rate, less complications, and can effectively maintain the cervical spine physiological curvature and intervertebral height. It is an ideal bone graft material.
【作者單位】： 南方醫(yī)科大學(xué)研究生學(xué)院;廣州軍區(qū)廣州總醫(yī)院脊柱外科;
【基金】：廣東省科技計(jì)劃項(xiàng)目(2015B020233013)
【分類號(hào)】：R687.3

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