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[1]張方舒,梅偉,王金爐,等.椎間融合器原位植骨與自體髂骨植骨治療脊髓型頸椎病的療效比較…[J].中醫(yī)正骨,2017,29(12):38-42.
　ZHANG Fangshu,MEI Wei,WANG Jinlu,et al.A clinical comparison of bone transplantation with cage in natural position versus autologous iliac bone transplantation for treatment of cervical spondylotic myelopathy[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2017,29(12):38-42.
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椎間融合器原位植骨與自體髂骨植骨治療脊髓型頸椎病的療效比較…()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第29卷
期數(shù):
2017年12期
頁(yè)碼:
38-42
欄目:
臨床研究
出版日期:
2017-12-20

文章信息/Info

Title:
A clinical comparison of bone transplantation with cage in natural position versus autologous iliac bone transplantation for treatment of cervical spondylotic myelopathy
作者:
張方舒1; 梅偉2; 王金爐1; 李格3; 欒繼耀1; 王坤1
1.河南中醫(yī)藥大學(xué),河南 鄭州 450046; 2.河南省鄭州市骨科醫(yī)院,河南 鄭州 450052; 3.河南中醫(yī)藥大學(xué)第一附屬醫(yī)院,河南 鄭州 450000
Author(s):
ZHANG Fangshu1; MEI Wei2; WANG Jinlu1; LI Ge3; LUAN Jiyao1; WANG Kun1
1.Henan University of Traditional Chinese Medicine,Zhengzhou 450046,Henan,China 2.Zhengzhou Orthopedic Hospital,Zhengzhou 450052,Henan,China 3.The First Affiliated Hospital of Henan University of Traditional Chinese Medicine,Zhengzhou 450000,Henan,China
關(guān)鍵詞:
頸椎病;  脊髓壓迫癥;  椎間盤(pán)切除術(shù);  脊柱融合術(shù);  骨移植;  髂骨;  椎間融合器
Keywords:
Key word cervical spondylosis;  spinal cord compression;  discectomy;  spinal fusion;  bone transplantation;  ilium;  cage
摘要:
目的:比較椎間融合器原位植骨與自體髂骨植骨治療脊髓型頸椎病的臨床療效。方法:回顧性分析2012年4月至2015年7月接受頸椎前路減壓椎間植骨融合術(shù)治療的70例脊髓型頸椎病患者的病例資料。男34例,女36例; 年齡30～66歲,中位數(shù)54歲。病變節(jié)段,C3～43例、C4～519例、C5～621例、C6～727例。術(shù)中充分減壓后,采用聚醚醚酮(polyetheretherketone,PEEK)椎間融合器原位植骨融合者歸入椎間融合器原位植骨組,采用自體髂骨植骨融合者歸入自體髂骨植骨組,每組35例。記錄2組患者的手術(shù)時(shí)間、術(shù)中出血量及住院時(shí)間。觀察植骨融合及并發(fā)癥發(fā)生情況。依據(jù)日本整形外科協(xié)會(huì)(Japanese orthopaedic association,JOA)脊髓型頸椎病評(píng)分標(biāo)準(zhǔn)分別對(duì)術(shù)前和術(shù)后12個(gè)月時(shí)患者頸椎情況進(jìn)行評(píng)價(jià),并對(duì)2組患者的頸椎JOA評(píng)分進(jìn)行比較。結(jié)果:70例患者均順利完成手術(shù)。椎間融合器原位植骨組較自體髂骨植骨組手術(shù)時(shí)間和住院時(shí)間短,術(shù)中出血量少[(49.5±5.1)min,(74.5±5.1)min,t=20.412,P=0.000;(6.9±0.5)d,(13.8±1.0)d,t=34.997,P=0.000;(44.5±3.6)mL,(60.3±5.1)mL,t=14.832,P=0.000]。2組患者均獲隨訪,隨訪時(shí)間12～15個(gè)月,中位數(shù)14個(gè)月。術(shù)后12個(gè)月,2組患者融合節(jié)段均達(dá)到骨性融合。術(shù)前2組患者頸椎JOA評(píng)分比較,差異無(wú)統(tǒng)計(jì)學(xué)意義[(9.8±0.8)分,(9.7±0.3)分,t=0.715,P=0.477]。術(shù)后12個(gè)月,2組患者頸椎JOA評(píng)分均高于術(shù)前[(16.7±0.5)分,(9.8±0.8)分,t=50.306,P=0.000;(14.0±0.6)分,(9.7±0.3)分,t=37.329,P=0.000],且椎間融合器原位植骨組高于自體髂骨植骨組[(16.7±0.5)分,(14.0±0.6)分,t=19.529,P=0.000]。椎間融合器原位植骨組術(shù)后無(wú)血腫、感染等并發(fā)癥發(fā)生。自體髂骨植骨組術(shù)后并發(fā)頸部切口血腫1例,血腫清除后切口愈合; 并發(fā)取骨處疼痛3例,未行特殊處理,術(shù)后3個(gè)月后疼痛緩解。結(jié)論:頸椎前路減壓植骨融合術(shù)治療脊髓型頸椎病,術(shù)中采用PEEK椎間融合器原位植骨比自體髂骨植骨更有利于頸椎功能的恢復(fù),且具有手術(shù)時(shí)間和住院時(shí)間短、術(shù)中出血量和術(shù)后并發(fā)癥少的優(yōu)勢(shì)。
Abstract:
ABSTRACT Objective:To compare the clinical effects of bone transplantation with cage in natural position versus autologous iliac bone transplantation for treatment of cervical spondylotic myelopathy(CSM).Methods:The medical records of 70 patients with CSM who received surgery of cervical decompression and intervertebral bone graft fusion in anterior access from April 2012 to July 2015 were analyzed retrospectively.The patients consisted of 34 males and 36 females,and ranged in age from 30 to 66 years(Median=54 yrs).The pathological changes located at C3～4(3),C4～5(19),C5～6(21)and C6～7(27).The patients were treated with adequate cervical decompression and intervertebral bone graft fusion with polyetheretherketone(PEEK)cage in natural position(group A)or autologous iliac bone(group B),35 cases in each group.The operative time,intraoperative blood loss,hospital stay,bone graft fusion rate and complication incidence were recorded and compared between the 2 groups.The cervical vertebras were evaluated according to Japanese orthopaedic association(JOA)CSM scoring standard before surgery and at 12 months after surgery respectively,and the JOA scores were compared between the 2 groups.Results:The surgeries were finished successfully in all patients.The operative time and hospital stay were shorter and the intraoperative blood loss were less in group A compared to group B(49.5+/-5.1 vs 74.5+/-5.1 min,t=20.412,P=0.000; 6.9+/-0.5 vs 13.8+/-1.0 days,t=34.997,P=0.000; 44.5+/-3.6 vs 60.3+/-5.1 ml,t=14.832,P=0.000).All patients in the 2 groups were followed up for 12-15 months with a median of 14 months,and all patients in the 2 groups achieved intervertebral osseous bone graft fusion.There was no statistical difference in JOA scores of cervical vertebra between the 2 groups before surgery(9.8+/-0.8 vs 9.7+/-0.3 points,t=0.715,P=0.477),and the JOA scores of cervical vertebra of the 2 groups were higher at 12 months after the surgery compared to pre-surgery(16.7+/-0.5 vs 9.8+/-0.8 points,t=50.306,P=0.000; 14.0+/-0.6 vs 9.7+/-0.3 points,t=37.329,P=0.000),and the JOA scores of cervical vertebra were higher in group A compared to group B at 12 months after the surgery(16.7+/-0.5 vs 14.0+/-0.6 points,t=19.529,P=0.000).No postoperative complications such as hematoma and infection were found in group A.Cervical incision hematoma(1)and bone donor site pain(3)were found in group B after surgery.The incision healed after the hematoma was cleared,and the bone donor site pain were relieved at 3 months after the surgery without special treatment.Conclusion:Bone transplantation with PEEK cage in natural position is more conducive to the cervical vertebra function recovery compared to autologous iliac bone transplantation in treatment of CSM with cervical decompression and intervertebral bone graft fusion in anterior access,and it has such advantages as shorter operative time and hospital stay,less intraoperative blood loss and postoperative complications.

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通訊作者:梅偉 E-mail:[email protected]
更新日期/Last Update: 2018-05-02