[1]马远,彭小荷,郭雄飞,等.纳米羟基磷灰石/聚酰胺66椎间融合器与钛网植骨融合治疗多节段脊髓型颈椎病的对比研究[J].中医正骨,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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纳米羟基磷灰石/聚酰胺66椎间融合器与钛网植骨融合治疗多节段脊髓型颈椎病的对比研究()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第32卷
期数:
2020年10期
页码:
19-25
栏目:
临床研究
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:
马远; 彭小荷; 郭雄飞; 程省; 宋博; 王挺; 叶向阳
(南阳市中心医院,河南 南阳 473003)
Author(s):
MA Yuan; PENG Xiaohe; GUO Xiongfei; CHENG Sheng; SONG Bo; WANG Ting; YE Xiangyang
Nanyang Central Hospital,Nanyang 473003,Henan,China
关键词:
颈椎病;  脊柱融合术;  椎间融合器;  纳米羟基磷灰石/聚酰胺66;  临床试验
Keywords:
cervical spondylosis;  spinal fusion;  cage;  nano-hydroxyapatite/polyamide 66;  clinical trial
摘要:
目的:比较纳米羟基磷灰石/聚酰胺66(nano-hydroxyapatite/polyamide 66,n-HA/PA66)椎间融合器与钛网植骨融合治疗多节段脊髓型颈椎病(cervical spondylotic myelopathy,CSM)的临床疗效及安全性。方法:回顾性分析52例接受颈前路椎体次全切减压植骨融合术治疗的多节段CSM患者的病例资料,其中采用n-HA/PA66椎间融合器者24例(n-HA/PA66组)、采用钛网者28例(钛网组)。男30例,女22例。年龄32～72岁,中位数58岁。2节段CSM38例,3节段CSM14例。比较2组患者的手术时间、术中出血量、术后引流量、住院时间、日本骨科学会(Japanese Orthopaedic Association,JOA)脊髓型颈椎病评分(17分法)、颈部疼痛视觉模拟量表(visual analogue scale,VAS)评分、融合节段高度、融合节段Cobb角、植骨融合率、植骨融合物沉降率及并发症发生情况。结果:2组患者手术时间、术中出血量、术后引流量、住院时间比较,组间差异均无统计学意义[(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]。术前和末次随访时,2组患者JOA脊髓型颈椎病评分比较,组间差异均无统计学意义[(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]; 末次随访时,2组患者JOA脊髓型颈椎病评分均高于术前(t=6.559,P=0.000; t=6.547,P=0.000)。术前和末次随访时,2组患者颈部疼痛VAS评分比较,组间差异均无统计学意义[(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]; 末次随访时,2组患者颈部疼痛VAS评分均低于术前(t=8.048,P=0.000; t=8.099,P=0.000)。术前2组患者融合节段高度比较,组间差异无统计学意义[(55.25±10.34)mm,(54.21±7.75)mm,t=0.414,P=0.681]; 末次随访时,n-HA/PA66组的融合节段高度高于钛网组[(63.19±9.23)mm,(58.32±7.20)mm,t=2.201,P=0.032],2组患者的融合节段高度均较术前增加(t=2.806,P=0.007; t=2.056,P=0.045)。术前2组患者融合节段Cobb角比较,组间差异无统计学意义[5.50°±4.07°,5.32°±3.11°,t=0.181,P=0.857]; 末次随访时,n-HA/PA66组的融合节段Cobb角大于钛网组[9.06°±3.28°,7.21°±1.34°,t=2.734,P=0.009],2组患者融合节段Cobb角均较术前增大(t=3.337,P=0.002; t=2.953,P=0.005)。末次随访时,n-HA/PA66组23例植骨融合,钛网组26例植骨融合; 2组患者的植骨融合率比较,差异无统计学意义(χ2=0.019,P=0.890)。末次随访时,n-HA/PA66组2例出现植骨融合物沉降,钛网组9例出现植骨融合物沉降; n-HA/PA66组的植骨融合物沉降率低于钛网组(χ2=4.392,P=0.036)。n-HA/PA66组3例出现C5神经根麻痹,采用非甾体类抗炎镇痛药治疗后症状消失; 2例出现脑脊液漏,经引流及加强换药后治愈; 1例出现吞咽困难,未进行特殊治疗,术后2周症状自然消失。钛网组4例出现C5神经根麻痹、1例出现脑脊液漏、2例出现吞咽困难,处理方法及结果与n-HA/PA66组相同; 1例出现切口浅表感染,经加强换药后治愈。2组患者并发症发生率比较,差异无统计学意义(χ2=0.084,P=0.772)。结论:采用n-HA/PA66椎间融合器与钛网行颈前路椎体次全切减压植骨融合治疗CSM,两者的短期疗效及安全性相当,但前者的融合节段高度、融合节段Cobb角、植骨融合物沉降率均优于后者。
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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备注/Memo

备注/Memo:
通讯作者:叶向阳 E-mail:yexyang2008@163.com
更新日期/Last Update: 2020-10-20