摘要
目的:比较椎间融合器原位植骨与自体髂骨植骨治疗脊髓型颈椎病的临床疗效。方法:回顾性分析2012年4月至2015年7月接受颈椎前路减压椎间植骨融合术治疗的70例脊髓型颈椎病患者的病例资料。男34例,女36例;年龄30~66岁,中位数54岁。病变节段,C_(3~4)3例、C_(4~5)19例、C_(5~6)21例、C_(6~7)27例。术中充分减压后,采用聚醚醚酮(polyetheretherketone,PEEK)椎间融合器原位植骨融合者归入椎间融合器原位植骨组,采用自体髂骨植骨融合者归入自体髂骨植骨组,每组35例。记录2组患者的手术时间、术中出血量及住院时间。观察植骨融合及并发症发生情况。依据日本整形外科协会(Japanese orthopaedic association,JOA)脊髓型颈椎病评分标准分别对术前和术后12个月时患者颈椎情况进行评价,并对2组患者的颈椎JOA评分进行比较。结果:70例患者均顺利完成手术。椎间融合器原位植骨组较自体髂骨植骨组手术时间和住院时间短,术中出血量少[(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组患者均获随访,随访时间12~15个月,中位数14个月。术后12个月,2组患者融合节段均达到骨性融合。术前2组患者颈椎JOA评分比较,差异无统计学意义[(9.8±0.8)分,(9.7±0.3)分,t=0.715,P=0.477]。术后12个月,2组患者颈椎JOA评分均高于术前[(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],且椎间融合器原位植骨组高于自体髂骨植骨组[(16.7±0.5)分,(14.0±0.6)分,t=19.529,P=0.000]。椎间融合器原位植骨组术后无血肿、感染等并发症发生。自体髂骨植骨组术后并发颈部切口血肿1例,血肿清除后切口愈合;并发取骨处疼痛3例,未行特殊处理,术后3个月后疼痛缓解。结论:颈椎前路减压植骨融合术治疗脊髓型颈椎病,术中采用PEEK椎间融合器原位植骨比自体髂骨植骨更有利于颈椎功能的恢复,且具有手术时间和住院时间短、术中出血量和术后并发症少的优势。
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 C 3~4(3),C 4~5(19),C 5~6(21)and C 6~7(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.
作者
张方舒
梅伟
王金炉
李格
栾继耀
王坤
ZHANG Fangshu;MEI Wei;WANG Jinlu;LI Ge;LUAN Jiyao;WANG Ku(Henan University of Traditional Chinese Medicine,Zhengzhou 450046,Henan,China;Zhengzhou Orthopedic Hospital,Zhengzhou 450052,Henan,China;The First Affiliated Hospital of Henan University of Traditional Chinese Medicine,Zhengzhou 450000,Henan,China)
出处
《中医正骨》
2017年第12期38-42,共5页
The Journal of Traditional Chinese Orthopedics and Traumatology
