摘要
目的观察应用自稳定零切迹3D打印人工椎体行颈椎前路椎体次全切减压、内固定融合术治疗颈椎后纵韧带骨化症的临床疗效。方法前瞻性随机对照研究。将2022年1至7月于漯河市中心医院确诊为颈椎后纵韧带骨化症患者按照信封随机法分为零切迹组(颈前路椎体次全切减压后,采用自稳定零切迹3D打印人工椎体行内固定融合术)和钛网组(颈前路椎体次全切减压后,采用钛网和钛板行内固定融合术)。记录比较两组手术时间、术中出血量、日本骨科学会(JOA)评分与改善率及术后假体沉降发生率、植骨融合情况。结果最终零切迹组21例患者、钛网组20例患者被纳入研究并完成随访。零切迹组男16例、女5例,年龄(48.0±12.7)岁。钛网组男14例、女6例,年龄(49.8±10.2)岁。41例患者均顺利完成手术,零切迹组手术时间(50.04±8.45)min、术中出血量(95.38±26.07)ml、住院费用(4.23±0.61)万元,钛网组则分别为(59.20±11.95)min、(93.10±27.86)ml和(4.21±0.67)万元,零切迹组手术时间短于钛网组(P=0.007),两组术中出血量、住院费用差异均无统计学意义(均P>0.05)。41例患者获得随访(14.29±1.45)个月,钛网组4例(20.0%)出现吞咽困难,零切迹组0例,两组对比差异有统计学意义(P=0.048)。所有患者术后均无切口内血肿、脊髓神经再压迫、气道危象、切口感染并发症,无钢板螺钉断裂、移位发生。末次随访时均骨性融合。术后12个月随访时,零切迹组JOA评分由术前的(10.33±1.71)分提高至(15.47±0.81)分,改善率为76.1%±15.7%;钛网组JOA评分由术前的(10.30±1.75)分提高至(15.30±0.92)分,改善率为73.2%±16.7%,两组间改善率对比差异无统计学意义(P=0.580)。术后12个月随访时,零切迹组1例(4.8%)、钛网组8例(40.0%)发生假体下沉,两组间差异有统计学意义(P=0.009)。结论采用自稳定零切迹3D打印人工椎体治疗颈椎后纵韧带骨化症,和钛网相对比,在取得良好手术疗效同时可缩短手术时间、减少术后慢性吞咽不适及假体下沉发生率。
Objective To observe the clinical efficacy of a 3D printed self-stable zero-profile artificial vertebral body for anterior cervical corpectomy decompression and fusion in the treatment of ossification of the posterior longitudinal ligament(OPLL)of the cervical spine.Methods In this prospective randomized controlled trial,patients diagnosed with OPLL in Luohe Central Hospital from January to July 2022 were divided into a zero-profile group(3D printed self-stable zero-profile artificial vertebral body was used for internal fixation and fusion after anterior cervical subtotal decompression,)and titanium-mesh group(titanium-mesh and titanium plate were used for internal fixation and fusion after anterior cervical subtotal decompression)according to envelope random method.Operation time,intraoperative blood loss,Japanese Orthopaedic Association(JOA)score and improvement rate,incidence of postoperative prosthesis subsidence,and bone graft fusion were recorded and compared between the two groups.Results Finally,21 patients in the zero notch group and 20 patients in the titanium mesh group were included in the study and were followed-up.In the zero-profile group,there were 16 males and 5 females,aged(48.0±12.7)years.In the titanium-mesh group,there were 14 males and 6 females,aged(49.8±10.2)years.All the 41 patients successfully completed the operation.In the zero-profile group,the surgical time was(50.04±8.45)minutes,the blood loss was(95.38±26.07)ml and the hospitalization cost was(42.32±6.12)thousand yuan.In the titanium-mesh group,the surgical time was(59.20±11.95)minutes,the blood loss was(93.10±27.86)ml and the hospitalization cost was(42.10±6.71)thousand yuan.The surgical time in the zero-profile group was shorter than that in the titanium-mesh group(P=0.007),and there was no statistically significant difference in blood loss and hospitalization costs between the two groups(both P>0.05).The 41 patients were followed-up for(14.29±1.45)months.Four cases(20.0%)in the titanium mesh group experienced swallowing difficulties and 0 cases in the zero incision group,the difference between the two groups was statistically significant(P=0.048).No intraoperative hematoma,spinal cord nerve recompression,airway crisis,incision infection complications,and no steel plate or screw breakage or displacement occurred after surgery.At the last follow-up,all cases had bone fusion.At the follow-up of 12 months after surgery,the JOA score of the zero incision group increased from preoperative(10.33±1.71)points to(15.47±0.81)points,with an improvement rate of 76.1%±15.7%;the JOA score of the titanium mesh group increased from(10.30±1.75)points to(15.30±0.92)points,with an improvement rate of 73.2%±16.7%;there was no statistically significant difference in improvement rate between the two groups(P=0.580).At the follow-up of 12 months after surgery,1 case(4.8%)in the zero incision group and 8 cases(40.0%)in the titanium mesh group experienced implant sinking,and the difference between the two groups was statistically significant(P=0.009).Conclusion Compared with titanium-mesh,3D printed self-stable zero-profile artificial vertebral body for the treatment of OPLL of the cervical spine can achieve good surgical efficacy,shorter surgical time,lower incidence of postoperative chronic swallowing discomfort,and can provide a better bone material bonding interface and be less prone to prosthesis settlement.
作者
李玉伟
李修智
谷世锋
徐静宜
崔巍
王海蛟
Li Yuwei;Li Xiuzhi;Gu Shifeng;Xu Jingyi;Cui Wei;Wang Haijiao(Department of Orthopedics,Luohe Central Hospital,Luohe 462000,China;Medical College of Zhengzhou University,Zhengzhou 450052,China)
出处
《中华医学杂志》
CAS
CSCD
北大核心
2024年第7期526-532,共7页
National Medical Journal of China
关键词
颈椎
颈椎后纵韧带骨化症
颈前路椎体次全切除减压融合术
3D打印微孔钛合金人工椎体
钛网
Cervical vertebrae
Ossification of posterior longitudinal ligament
Anterior cervical corpectomy decompression and fusion
3D printing artificial vertebral body
Titanium mesh
