颈前路椎体次全切植骨融合手术术后钛笼塌陷观察及其原因分析

摘要

目的 探讨颈前路椎体次全切植骨融合手术(Anterior cervical corpectomy and fusion,ACCF)术后钛笼塌陷的发生率以及钛笼塌陷的影响因素.方法 回顾性分析我科室收治的42例脊髓型颈椎病及后纵韧带骨化患者ACCF术前、术后及末次随访时节段Cobb角、椎间前缘高度、椎间后缘高度等指标以评价术后手术节段的变化情况.结果 术后6月41例患者(97.6％)手术节段达到骨性融合,1例患者术后12月骨性融合.42例患者中11例发生钛笼重度塌陷(26.2％).其中2例出现颈部疼痛、神经症状复发等情况.末次随访时时,重度钛笼塌陷组在椎间前缘高度及椎间后缘高度低于未塌陷组,节段Cobb角大于未塌陷组.结论 ACCF术后钛笼塌陷率高,且重度钛笼塌陷可引起颈部疼痛、神经症状复发等并发症.术中应注意终板的保护、钛笼的裁减,以一定程度地防止钛笼塌陷的发生.%Objective To evaluate the incidence of titanium mesh cage (TMC) subsidence and its influence factors in the anterior cervical corpectomy and fusion (ACCF).Methods We retrospectively analyzed the outcomes of 42 patients who were diagnosed with cervical spondylotic myelopathy and ossification of posterior longitudinal ligament.The segmental Cobb angle and the anterior and posterior intervertebral height were recorded preoperatively,postoperatively and in the last fellow-up.Results 41patients obtained solid bony fusion 6 months after the surgery,l patient occurred delayed fusion and obtained solid bony fusion 12 months after the surgery.11 patients occurred severe TMC subsidence (26.2％).Among these patients,2 occurred neck pain and neurologic symptoms relapse.In the last follow-up,compared with the patient who did not occur TMC subsidence,the anterior and posterior intervertebral height were significantly lower in the patients who occurred severe TMC subsidence.But the segmental Cobb angle further improved in the severe TMC subsidence group.Conclusion TMC subsidence is a common complication in ACCF and is associated with neck pain and neurologic symptoms relapse.During the surgery,the endplate should be carefully protected and the way of clipping of the TMC should be noted.