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[1]馬遠,彭小荷,郭雄飛,等.納米羥基磷灰石/聚酰胺66椎間融合器與鈦網(wǎng)植骨融合治療多節(jié)段脊髓型頸椎病的對比研究[J].中醫(yī)正骨,2020,32(10):19-25.
　MA Yuan,PENG Xiaohe,GUO Xiongfei,et al.A comparative study of bone graft fusion with nano-hydroxyapatite/polyamide 66 cage versus titanium mesh cage for treatment of multiple-segment cervical spondylotic myelopathy[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2020,32(10):19-25.
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納米羥基磷灰石/聚酰胺66椎間融合器與鈦網(wǎng)植骨融合治療多節(jié)段脊髓型頸椎病的對比研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第32卷
期數(shù):
2020年10期
頁碼:
19-25
欄目:
臨床研究
出版日期:
2020-10-20

文章信息/Info

Title:
A comparative study of bone graft fusion with nano-hydroxyapatite/polyamide 66 cage versus titanium mesh cage for treatment of multiple-segment cervical spondylotic myelopathy
作者:
馬遠; 彭小荷; 郭雄飛; 程省; 宋博; 王挺; 葉向陽
(南陽市中心醫(yī)院,河南 南陽 473003)
Author(s):
MA Yuan; PENG Xiaohe; GUO Xiongfei; CHENG Sheng; SONG Bo; WANG Ting; YE Xiangyang
Nanyang Central Hospital,Nanyang 473003,Henan,China
關(guān)鍵詞:
頸椎病;  脊柱融合術(shù);  椎間融合器;  納米羥基磷灰石/聚酰胺66;  臨床試驗
Keywords:
cervical spondylosis;  spinal fusion;  cage;  nano-hydroxyapatite/polyamide 66;  clinical trial
摘要:
目的:比較納米羥基磷灰石/聚酰胺66(nano-hydroxyapatite/polyamide 66,n-HA/PA66)椎間融合器與鈦網(wǎng)植骨融合治療多節(jié)段脊髓型頸椎病(cervical spondylotic myelopathy,CSM)的臨床療效及安全性。方法:回顧性分析52例接受頸前路椎體次全切減壓植骨融合術(shù)治療的多節(jié)段CSM患者的病例資料,其中采用n-HA/PA66椎間融合器者24例(n-HA/PA66組)、采用鈦網(wǎng)者28例(鈦網(wǎng)組)。男30例,女22例。年齡32～72歲,中位數(shù)58歲。2節(jié)段CSM38例,3節(jié)段CSM14例。比較2組患者的手術(shù)時間、術(shù)中出血量、術(shù)后引流量、住院時間、日本骨科學會(Japanese Orthopaedic Association,JOA)脊髓型頸椎病評分(17分法)、頸部疼痛視覺模擬量表(visual analogue scale,VAS)評分、融合節(jié)段高度、融合節(jié)段Cobb角、植骨融合率、植骨融合物沉降率及并發(fā)癥發(fā)生情況。結(jié)果:2組患者手術(shù)時間、術(shù)中出血量、術(shù)后引流量、住院時間比較,組間差異均無統(tǒng)計學意義[(147.60±30.32)min,(150.48±28.77)min,t=0.351,P=0.727;(130.20±42.67)mL,(127.78±45.43)mL,t=0.197,P=0.845;(57.28±10.20)mL,(60.35±12.56)mL,t=0.957,P=0.343;(15.72±4.32)d,(14.38±5.57)d,t=0.957,P=0.343]。術(shù)前和末次隨訪時,2組患者JOA脊髓型頸椎病評分比較,組間差異均無統(tǒng)計學意義[(12.32±1.23)分,(11.62±2.21)分,t=1.378,P=0.174;(15.25±1.81)分,(15.10±1.74)分,t=0.304,P=0.762]; 末次隨訪時,2組患者JOA脊髓型頸椎病評分均高于術(shù)前(t=6.559,P=0.000; t=6.547,P=0.000)。術(shù)前和末次隨訪時,2組患者頸部疼痛VAS評分比較,組間差異均無統(tǒng)計學意義[(4.34±1.53)分,(4.55±1.75)分,t=0.457,P=0.650;(1.31±1.03)分,(1.48±0.98)分,t=0.609,P=0.545]; 末次隨訪時,2組患者頸部疼痛VAS評分均低于術(shù)前(t=8.048,P=0.000; t=8.099,P=0.000)。術(shù)前2組患者融合節(jié)段高度比較,組間差異無統(tǒng)計學意義[(55.25±10.34)mm,(54.21±7.75)mm,t=0.414,P=0.681]; 末次隨訪時,n-HA/PA66組的融合節(jié)段高度高于鈦網(wǎng)組[(63.19±9.23)mm,(58.32±7.20)mm,t=2.201,P=0.032],2組患者的融合節(jié)段高度均較術(shù)前增加(t=2.806,P=0.007; t=2.056,P=0.045)。術(shù)前2組患者融合節(jié)段Cobb角比較,組間差異無統(tǒng)計學意義[5.50°±4.07°,5.32°±3.11°,t=0.181,P=0.857]; 末次隨訪時,n-HA/PA66組的融合節(jié)段Cobb角大于鈦網(wǎng)組[9.06°±3.28°,7.21°±1.34°,t=2.734,P=0.009],2組患者融合節(jié)段Cobb角均較術(shù)前增大(t=3.337,P=0.002; t=2.953,P=0.005)。末次隨訪時,n-HA/PA66組23例植骨融合,鈦網(wǎng)組26例植骨融合; 2組患者的植骨融合率比較,差異無統(tǒng)計學意義(χ2=0.019,P=0.890)。末次隨訪時,n-HA/PA66組2例出現(xiàn)植骨融合物沉降,鈦網(wǎng)組9例出現(xiàn)植骨融合物沉降; n-HA/PA66組的植骨融合物沉降率低于鈦網(wǎng)組(χ2=4.392,P=0.036)。n-HA/PA66組3例出現(xiàn)C5神經(jīng)根麻痹,采用非甾體類抗炎鎮(zhèn)痛藥治療后癥狀消失; 2例出現(xiàn)腦脊液漏,經(jīng)引流及加強換藥后治愈; 1例出現(xiàn)吞咽困難,未進行特殊治療,術(shù)后2周癥狀自然消失。鈦網(wǎng)組4例出現(xiàn)C5神經(jīng)根麻痹、1例出現(xiàn)腦脊液漏、2例出現(xiàn)吞咽困難,處理方法及結(jié)果與n-HA/PA66組相同; 1例出現(xiàn)切口淺表感染,經(jīng)加強換藥后治愈。2組患者并發(fā)癥發(fā)生率比較,差異無統(tǒng)計學意義(χ2=0.084,P=0.772)。結(jié)論:采用n-HA/PA66椎間融合器與鈦網(wǎng)行頸前路椎體次全切減壓植骨融合治療CSM,兩者的短期療效及安全性相當,但前者的融合節(jié)段高度、融合節(jié)段Cobb角、植骨融合物沉降率均優(yōu)于后者。
Abstract:
To compare the clinical curative effects and safety of bone graft fusion with nano-hydroxyapatite/polyamide 66(n-HA/PA66)cage versus titanium mesh(TM)cage for treatment of multiple-segment cervical spondylotic myelopathy(CSM).Methods:The medical records of 52 patients who received anterior cervical corpectomy and fusion(ACCF)for treatment of multiple-segment CSM were analyzed retrospectively.Twenty-four patients were treated with n-HA/PA66 cage(n-HA/PA66 group),while the others were treated with TM cage(TM group).The patients consisted of 30 males and 22 females,and ranged in age from 32 to 72 years(Median=58 yrs).The pathological changes located at two segments(38 cases)and three segments(14 cases)respectively.The operative time,intraoperative blood loss,postoperative drainage volume,hospital stay,Japanese Orthopedic Association(JOA)CSM scores,neck pain visual analogue scale(VAS)score,height and Cobb angle of fused segment,bone graft fusion rate,subsidence rate of cage and complications were compared between the 2 groups.Results:There was no statistical difference in operative time,intraoperative blood loss,postoperative drainage volume and hospital stay between the 2 groups(147.60+/-30.32 vs 150.48+/-28.77 min,t=0.351,P=0.727; 130.20+/-42.67 vs 127.78+/-45.43 mL,t=0.197,P=0.845; 57.28+/-10.20 vs 60.35+/-12.56 mL,t=0.957,P=0.343; 15.72+/-4.32 vs 14.38+/-5.57 days,t=0.957,P=0.343).There was no statistical difference in JOA CSM score between the 2 groups before the surgery and at last follow-up(12.32+/-1.23 vs 11.62+/-2.21 points,t=1.378,P=0.174; 15.25+/-1.81 vs 15.10+/-1.74 points,t=0.304,P=0.762).The JOA CSM scores increased in the 2 groups at last follow-up compared to pre-surgery(t=6.559,P=0.000; t=6.547,P=0.000).There was no statistical difference in neck pain VAS score between the 2 groups before the surgery and at last follow-up(4.34+/-1.53 vs 4.55+/-1.75 points,t=0.457,P=0.650; 1.31+/-1.03 vs 1.48+/-0.98 points,t=0.609,P=0.545).The neck pain VAS scores decreased in the 2 groups at last follow-up compared to pre-surgery(t=8.048,P=0.000; t=8.099,P=0.000).There was no statistical difference in the height of fused segment between the 2 groups before the surgery(55.25+/-10.34 vs 54.21+/-7.75 mm,t=0.414,P=0.681).The height of fused segment was higher in n-HA/PA66 group compared to TM group at last follow-up(63.19+/-9.23 vs 58.32+/-7.20 mm,t=2.201,P=0.032),and increased in the 2 groups at last follow-up compared to pre-surgery(t=2.806,P=0.007; t=2.056,P=0.045).There was no statistical difference in the Cobb angle of fused segment between the 2 groups before the surgery(5.50+/-4.07 vs 5.32+/-3.11 degrees,t=0.181,P=0.857).The Cobb angle of fused segment was greater in n-HA/PA66 group compared to TM group at last follow-up(9.06+/-3.28 vs 7.21+/-1.34 degrees,t=2.734,P=0.009),and increased in the 2 groups at last follow-up compared to pre-surgery(t=3.337,P=0.002; t=2.953,P=0.005).At last follow-up,the bone graft fusion was found in 23 patients in n-HA/PA66 group and 26 patients in TM group.There was no statistical difference in bone graft fusion rate between the 2 groups(χ2=0.019,P=0.890).The subsidence of cage was found in 2 patients in n-HA/PA66 group and 9 patients in TM group,and the subsidence rate of cage was lower in n-HA/PA66 group compared to TM group(χ2=4.392,P=0.036).等

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更新日期/Last Update: 2020-10-20