颈前路减压支撑融合钢板内固定术治疗脊髓型颈椎病

目的 探讨颈前路减压、椎体间植骨支撑融合或颈椎椎间融合器（钛网或Cage）支撑融合、钢板内固定术治疗脊髓型颈椎病的临床方法及疗效。方法 回顾分析66例脊髓型颈椎病患者行颈前路减压后,分别采取骼骨植骨支撑融合、颈椎间融合器（钛网或Cage）植入支撑融合,钢板内固定术,随访时间平均32个月,采用Zdeblick影像学判定椎体间融合的标准,贾连顺的评定法评定术后临床疗效。结果 在颈前路减压、钢板内固定术治疗脊髓型颈椎病方法中,自体骼骨植骨融合优良率87．5％,供区并发症12．1％,椎间盘退变椎问高度丢失7．6％;颈椎间融合器支撑融合优良率96．1％,无供区并发症和椎问盘退变椎间高度丢失。结论 颈前路减压、椎体间植骨融合或颈椎间融合器支撑融合、钢板内固定术治疗脊髓型颈椎病临床疗效满意。钢板内固定术后颈椎即刻稳定;植骨融合手术操作简单,费用少,但存在供区并发症、椎问高度丢失;椎间融合器融合稳定、牢固,椎间高度丢失少,后者疗效优于前者。     

腰椎椎间融合器临床应用的中期疗效观察

目的探讨应用腰椎椎间融合器术后中期腰椎的融合率及临床疗效。方法对45例腰椎不稳及滑脱椎间植入Cage行椎间融合术。一枚Cage植入2例,双侧Cage固定2例,一侧Cage植入加对侧棘突、小关节突螺钉固定6例,Cage植入加椎弓根系统固定35例。结果随访3~7年,平均4·5年,融合率100%,临床疗效88·89%。结论腰椎椎间融合器是一种可靠的脊柱融合辅助器材。     

自锁式颈椎融合器ROI-C与前路钛板固定联合cage植骨融合治疗老年性脊髓型颈椎病的对比研究

目的：比较新型自锁式颈椎融合器ROI-C与钛板联合Cage植骨融合治疗老年性脊髓型颈椎病的安全性。方法：回顾性分析我院从2012年1月至2013年9月收治的58例脊髓型颈椎病患者,其中行颈椎前路减压ROI-C椎间融合的患者23例（ROI-C组）,行前路钛板内固定联合Cage椎间融合的患者35例（钛板组）,对比两组患者手术时间、术中出血量、术后复苏时间、术后住院时间,随访常规复查颈椎正侧位X片并观察有无感染、食道损伤破裂、植入物移位、松动、断裂、术后吞咽困难等并发症。结果： ROI-C组在手术时间、术中失血量、术后住院时间明显低于钛板组,其差异存在统计学意义（P ＜0.05）。术后平均随访14.1个月（12-22个月）,ROI-C组1例发生吞咽困难,钛板组9例发生吞咽困难,两组吞咽困难发生率差异有统计学意义（P ＜0.05）。两组均未见手术节段不稳。结论：治疗老年性脊髓型颈椎病,采用自锁式颈椎融合器ROI-C比前路钛板固定联合Cage植骨融合更具安全性。ROI-C较前路钛板联合Cage植骨融合在减少手术损伤、减少术中出血、缩短手术时间及术后住院时间、降低吞咽困难等术后并发症方面更具优势,值得临床加大推广应用。     

颈前路钛网和钢板联合Cage治疗非连续性多节段颈椎病

[目的]探讨应用钛网和前路钛钢板联合椎间融合器(Cage)治疗15例非连续节段性颈椎病的疗效.[方法]应用钛网和前路钛钢板联合Cage前路减压和重建,治疗15例非连续节段性颈椎病患者,影像学和临床神经学检查评估治疗效果.[结果]随访时间6个月～3年1个月,用神经功能评价(JOA评分),术前为(6.8±2.4)分,术后为(11.6±1.6)分;15例影像学融合;无内固定松动断裂、椎体间融合器下沉等并发症.[结论]非连续节段性颈椎病,如果交界节段无退变和不稳,保留交界节段分别对受累节段进行减压和固定融合,是有效和安全的治疗方法.     

颈前路分节段减压植骨融合术治疗多节段颈椎病

目的探讨颈前路分节段减压植骨融合术治疗多节段颈椎病的可行性及疗效。方法对11例病变累及3个以上椎间隙脊髓型颈椎病患者,采用经颈前路单椎体次全切除,钛网内充填减压椎体松质骨植骨融合,单间隙减压采用聚醚醚酮椎间融合器植骨融合,并行带锁钢板固定。结果11例均获随访,平均15个月,植骨于术后12～16周骨性愈合。术后恢复的椎间高度未发生再丢失现象,颈椎生理曲度维持良好,无钢板及螺钉折断、椎间融合器滑脱、植骨不融合等并发症。手术时间150min（120～240min）,JOA评分由平均术前8．3分上升至术后13分。结论颈前路分节段减压植骨融合术治疗多节段颈椎病及带锁钢板内固定应用前景良好。     

可吸收腰椎椎间融合器的近期疗效观察

目的将可吸收材料聚-D,L-乳酸(PDLLA)制成腰椎间融合器,通过临床应用研究,观察并评估其临床效果,探讨其在临床应用中的意义,为进一步加以改进和临床应用提供基础。方法将可吸收腰椎椎间融合器应用于腰椎疾病患者的后路减压椎间植骨融合内固定术中,术后随访6月,行VAS评分、JOA评分、X线及CT三维重建观察患者症状改善、局部反应、并发症、植骨融合率、神经功能改善、椎间植骨融合情况可吸收椎间融合器(Lumbar Absorbable Design Fu-sion Cage LADFC)的降解情况,评估腰椎可吸收椎间融合器的临床效果。结果所有患者随访6月,术后无明显局部反应;植骨融合率3个月为92.3%,6个月为100%;可吸收椎间融合器的CT值术后1周与术后3月及与术后6相比无显著性差异;VAS评分、JOA评分结果均显示术后6月与术前相比有显著性差异;临床评估良好。结论可吸收椎间融合器在临床应用过程中能够较好的缓解患者的症状;具有良好的植骨融合率,对植骨融合无明显的负面影响,能够逐步降解、吸收,被骨组织替代,但所需时间较长。     

多节段脊髓型颈椎病的前路手术治疗

目的探讨多节段脊髓型颈椎病经前路行减压、植入椎间融合器（Cage）、钢板内固定术的治疗效果。方法对31例多节段脊髓型颈椎病均行经颈前路减压、植入Cage钢板内固定术。结果31例均获得随访,时间18～36（23±1.5）个月,椎间隙在15～24周内融合,术中减压较彻底,术后恢复融合节段间隙高度,未出现再丢失现象,颈椎生理曲度维持良好,椎间融合率达100%。未发生邻近节段退变。结论经颈前路行减压、植入Cage加钢板内固定治疗多节段脊髓型颈椎病效果满意,但对邻近节段退变现象仍需长期观察。     

腰椎融合术后融合器移位的原因及处理对策

椎间融合器（ Cage ）在腰椎稳定性重建术中占有重要地位,被广泛应用于脊柱退行性变、脊柱不稳症等疾病的治疗。随着 Cage 临床应用越来越广泛,Cage移位和沉陷等相关并发症也越来越受到临床关注,其中术后Cage移位是较严重的并发症之一,可能导致融合失败、神经根损伤等严重后果,其相关临床报道也逐渐增加。     

椎间植骨融合与加用B-Twin融合治疗下腰椎不稳

目的比较椎间单纯植骨融合与加用可膨胀式椎间融合器（B-Tw in）两种不同融合方法治疗下腰椎不稳的临床疗效。方法对按同一标准选择的36例下腰椎不稳的患者进行前瞻性研究,根据入院顺序随机分为两组。分析两组患者术后的临床疗效、植骨融合率、椎间隙高度及并发症等有无差异。应用SPSS 13.0统计软件对结果进行统计分析。结果两组病例临床疗效、植骨融合率无明显差异（P〉0.05）,但椎间隙高度有差别,椎间植骨融合组椎间隙高度丢失较多。结论自体骨与可膨胀式椎间融合器（B-Tw in）是治疗下腰椎不稳的良好融合材料。后路椎间单纯植骨融合（以下简称）治疗费用较低,无免疫排斥反应,但其术后椎间隙高度丢失较加用可膨胀式椎间融合器（以下简称B-Tw in融合）多;B-Tw in融合术后恢复较快,但治疗费用较高。     

SRS复位固定加Cage椎间融合治疗腰椎滑脱症

目的 探讨应用SRS椎弓根系统复位固定、后路全椎板减压加斜向植入单枚Cage的椎间融合术治疗腰椎滑脱症的疗效.方法 对69例腰椎滑脱症采用全椎板减压、SRS椎弓根系统复位固定,并以后路单枚椎间融合器后斜向植人技术进行治疗.结果 滑脱椎体均获得骨性融合.根据MacNab评定标准,优良率为98.5%.术后无内固定物松动、断裂、椎间融合器下沉等并发症.结论 SRS椎弓根系统和单枚Cage在治疗腰椎滑脱症中具有协同作用,可增强腰椎固定后的稳定性,提高了椎间融合率,是治疗腰椎滑脱症的理想术式.     

颈椎椎间融合器临床应用的失误及并发症分析

目的：探讨颈椎椎间融合器(cervical fusion cage,CFC)临床应用的失误及并发症产生的原因。方法：随访96例植入CFC的脊髓型颈椎病、急性颈椎间盘突出、外伤性颈椎不稳患者，总结CFC临床应用的失误及并发症，并分析产生的原因。结果：3例CFC的植入位置不当，7例患者产生并发症，包括颈椎的生理前凸减小或变直、CFC旋转、脱位、下沉、不融合。产生失误及并发症的原因有：手术操作不当、CFC自身设计不完善、融合节段过多等。结论：减少失误、降低并发症发生率的对策是严格掌握CFC的适应证、规范手术操作、改进CFC的设计。     

自稳型颈椎融合器在颈椎前路融合手术中的临床应用

目的:探讨自稳型颈椎融合器在颈椎前路融合手术中应用的临床效果。方法:2011年1月至2014年1月,采用椎间盘切除,自体髂骨植骨自稳型颈椎融合器椎间融合术治疗颈椎疾患50例,其中男32例,女18例;年龄30～79岁,平均53.30岁;颈椎病22例,外伤性颈椎间盘突出症26例,颈椎失稳2例;单节段32例,双节段15例,3节段3例。采用日本骨科协会评定标准(Japan Orthopedic Association,JOA)对神经功能进行评估;采用Otani 分级方法对疗效进行评定;定期拍摄颈椎正侧位X线片和动力位X线片观察颈椎曲度和骨融合情况以及有无内固定相关并发症;采用Suk法评估骨融合情况。结果:50例患者均获得随访,时间6～36个月,平均20个月。术后未见明显的手术相关并发症,均达到骨性融合,平均融合时间 4.30个月。JOA评分术后1周为16.10±2.20,术后6个月为16.40±2.35,较术前的10.60±3.00均明显提高(P<0.05).采用Otani分级方法进行疗效评定,优40例,良 9例,可1例。随访期间未出现明显的吞咽困难、融合器移位等内固定相关并发症。结论:在颈椎前路融合手术中使用自稳型颈椎融合器疗效满意,且手术创伤小,能减少手术相关并发症的发生,是颈椎前路融合手术中一种较好的融合方法。     

Long-term follow-up results in patients with cervical disk disease treated by cervical anterior fusion using titanium cage implants

This study is a retrospective analysis of 146 patients, 85 males and 61 females aged 21-80 years (mean 52 years), with cervical disk disease who underwent anterior fusion and titanium cage implantation with follow-up periods of no less than 72 months after surgery. All patients underwent the conventional anterior cervical approach. After removing the protruded disk and osteophyte, cylindrical titanium cages were placed. Single, two, and three level fusion was performed in 76 (52%), 64 (44%), and 6 (4%) patients, respectively. Functional assessment used the Neurosurgical Cervical Spine Scale (NCSS). The curvature index and range of motion were evaluated pre- and postoperatively. The clinical outcomes were satisfactory and there were no significant complications. The mean NCSS was 9.7 before and 12.7 at 1 year after the operation, and 12.1 at final examination. No postoperative cage extrusion or pseudoarthrosis occurred, but the cages descended in 10 patients (7%) although alignment was satisfactory. At 5 years after the operation, 140 of the 146 patients (96%) had solid fusion. The long-term results of anterior fusion with titanium cage implantation in patients with cervical disk disease were satisfactory. Titanium cage placement is a highly useful alternative to the conventional treatment method in these patients.     

颈前路多节段融合术后吞咽困难的原因分析

目的 比较多节段颈前路椎间盘切除减压融合术中采用传统钢板+cage和“零切迹”颈椎椎间融合器植入患者术后吞咽困难的发生情况,并分析其原因.方法 2008年9月至2011年9月,接受颈前路椎间盘切除减压+前路钢板+cage植入的118例多节段颈椎病患者为钢板cage组,接受颈前路椎间盘切除减压+Zero-p颈椎椎间融合器植入的108例患者为Zero-p组.分别于术前、术后第2天、术后3、6、12个月及末次随访时采用日本矫形外科学会评分法(Japan orthopedic association,JOA)对患者的神经功能情况进行评估;摄颈椎X片评价植骨融合程度、内固定相关并发症及椎前软组织肿胀程度;采用Bazaz吞咽困难分级及改良吞咽生活质量量表(swallowing-quality of life,SWAL-QOL)评估患者吞咽困难的发生率及相关症状发生情况.结果 随访时间平均为2.4年(1.0～3.5年).术后第2天钢板cage组发生吞咽困难49例(41.53％)明显高于Zero-p组(36例,33.33％);钢板cage组术后第2天及术后2个月椎前软组织厚度明显大于Zero-p组.术后第2天Zero-p组中手术范围为C3～C6的患者吞咽困难发生率(43.1％)明显高于手术范围为C4～C7的患者(22％).结论 颈前路多节段融合术后吞咽困难不可避免,内固定的选择和手术范围是术后吞咽困难发生的重要影响因素.使用颈椎“零切迹”植入物可以减少术后吞咽困难的发生率,手术节段越高术后吞咽困难的发生率越高.     

A prospective randomized multicenter clinical evaluation of an anterior cervical fusion cage

STUDY DESIGN: A prospective, concurrently controlled, randomized, multicenter trial of an anterior Bagby and Kuslich cervical fusion cage (BAK/C; Sulzer Spine-Tech, Minneapolis, MN) for treatment of degenerative disc disease of the cervical spine. OBJECTIVES: To report clinical results with maximum 24-month follow-up of fusions performed with the BAK/C fusion cage. SUMMARY OF BACKGROUND DATA: Threaded lumbar cages have been used during the past decade as a safe and effective surgical solution for chronic disabling low back pain. Threaded cages have now been developed for use in anterior cervical interbody fusions to obviate the need for allografts or autogenous bone grafting procedures while providing initial stability during the fusion process. METHODS: Patients with symptomatic cervical discogenic radiculopathy were treated with either anterior cervical discectomy with uninstrumented bone-only fusion (ACDF) or BAK/C fusion cage(s). Independent radiographic assessment of fusion was made and patient-based outcome was assessed by visual analog pain scale and a Short Form (SF)-36 Health Status Questionnaire. RESULTS: Data analysis included 344 patients at 1 year and 180 at 2 years. When the two cage groups (hydroxya, patite-coated or noncoated) were compared with the ACDF group, similar outcomes were noted for duration of surgery, hospital stay, improvements in neck pain and radicular pain in the affected limb, improvements in the SF-36 Physical Component subscale and Mental Component subscale, and the patients' perception of overall surgical outcome. Symptom improvements were maintained at 2 years. A greater percentage of patients with ACDF needed an iliac crest bone harvest than did BAK/C patients (67% vs.- 3%). Successful fusion for one-level procedures at 12 months was 97.9% for the BAK/C groups and 89.7% for the ACDF group (P < 0.05). The complication rate for the ACDF group was 20.4% compared with an overall complication rate of 11.8% with BAK/C. There was no difference in complications that necessitated a second operative procedure. CONCLUSIONS: These results demonstrate that outcomes after a cervical fusion procedure with a threaded cage are the same as those of a conventional uninstrumented bone-only anterior discectomy and fusion with a low risk of complications and rare need for autogenous bone graft harvest.     

Cage containing a biphasic calcium phosphate ceramic (Triosite) for the treatment of cervical spondylosis

BACKGROUND: We evaluated the fusion efficacy and clinical outcomes of a cage containing a biphasic calcium phosphate ceramic (Triosite) in treating cervical spondylosis. METHODS: We randomly divided 100 patients with cervical spondylosis undergoing anterior discectomy with interbody polyetheretherketone (PEEK) fusion into 2 groups in the past 2 years: group A (n = 50), PEEK cage containing a biphasic calcium phosphate ceramic (Triosite), and group B (n = 50), PEEK cage containing an autogenous iliac bone graft. We compared the fusion rate, fusion time, spinal curvature, and neuroforamen size between the 2 groups. We also compared excess operation time, excess blood loss, hospital stay, complications, and neurological recovery status between the groups. RESULTS: The fusion rates were 57%, 67%, 77%, 82%, 92%, and 100% in group A and 81%, 86%, 95%, 95% 100%, and 100% in group B in the first 6 postoperative months. The fusion rate in group A was significantly lower than that in group B in the first 5 months after the procedure (P < .05 and P < .01, respectively), but the fusion rate reached 100% in both groups by the sixth month. Within the first 6 months, as the fusion level increased, the fusion rates reduced and time to fusion was delayed in both groups. There were no donor site complications in group A. However, 3 patients (6%) from group B experienced complications (1, wound infection; 1, numbness of thigh; and 1, subcutaneous hematoma) (P < .001). The hospital stay was shorter in group A (4.43 +/- 2.36 days) than in group B (7.00 +/- 3.77 days) (P = .001). The mean excessive blood loss and excessive operative time for an iliac bone graft in group B were 15 +/- 5 mL and 10 +/- 6 minutes. There was no statistical significance in spinal curve correction, neuroforamen enlargement, and neurological recovery. CONCLUSIONS: A cage containing a biphasic calcium phosphate ceramic resulted in complete fusion by the sixth postoperative month, although the fusion rate was lower than that in a cage containing an autograft during the first 5 months after the operation and the time to fusion was delayed. Using a cage containing a biphasic calcium phosphate ceramic leads to a shorter hospital stay, less blood loss, shorter operative time, and no donor site complications. It seemed to be a good substitute for cervical spondylotic fusion.     

Preliminary experience using a polyetheretherketone (PEEK) cage in the treatment of cervical disc disease

OBJECTIVE: We investigated the effectiveness of a new material, polyetheretherketone (PEEK), in a spinal cage used in performing cervical spinal fusion for the correction of cervical kyphosis. METHODS: A total of 80 patients with various cervical diseases were divided into two groups. Patients in Group A (40 patients) underwent microdiscectomy and PEEK cage fusion, and patients in Group B (40 patients) were treated with microdisectomy and autogenous iliac crest graft (AICG) fusion. We evaluated the patients for cervical lordosis, the height of the foramina, the cross sectional area of the foramina, and fusion status on the basis of x-rays. The patients' neurological and functional outcomes were assessed on the basis of the Prolo scale. Magnetic resonance imaging was also performed for spinal cord evaluation. RESULTS: The use of the PEEK cage in patients who undergo spinal fusion may increase cervical lordosis (mean, 2.33 +/- 3.00 mm; P = 0.03), whereas AICG fusion may not (mean, -0.84 +/- 6.69 mm; P = 0.49). The use of the PEEK cage was found to increase the height of the foramina (mean, 2.54 +/- 1.40 mm; P = 0.00) and increase its cross sectional area (mean, 40.36 +/- 23.53 mm2; P = 0.00). The height of the foramina increased only in the PEEK group postoperatively. The cross sectional area of the foramina increased in both groups postoperatively. The complication rate in patients who underwent fusion procedures with the PEEK cage was less than that in patients who underwent fusion with AICG fusion (2.50 versus 17.50%; P = 0.03). Both groups had a satisfactory fusion rate (100 versus 93.1%). The patients' postoperative Prolo scale scores were statistically better in the PEEK group (8.50 +/- 1.49 versus 7.17 +/- 2.13; P = 0.00), and more patients in the PEEK group than in the AICG group achieved excellent outcomes (66.63 versus 28.57%; P = 0.00). Because PEEK is radiotransparent on x-rays and few artifacts are seen on magnetic resonance imaging scans, it is better suited than autogenous iliac crest donor material for postoperative radiographic evaluation. CONCLUSION: The PEEK cage provides solid fusion, increased cervical lordosis, and increased height and cross sectional area of the foramina. There are few complications associated with the use of this cage, and the functional and neurological outcomes are satisfactory. It also facilitates postoperative x-ray and magnetic resonance imaging evaluation. The PEEK cage is therefore a good substitute for AICG fusion in patients with cervical disc disease.     

颈椎前路减压cage与zero-p椎间植骨融合内固定治疗单节段脊髓型颈椎病的疗效比较

目的比较颈椎前路减压cage椎间植骨融合钛板内固定与zero-p椎间植骨融合内固定治疗单节段脊髓型颈椎病的临床疗效及并发症情况。方法纳入自2013-06—2015-06诊治的110例单节段脊髓型颈椎病,采用颈椎前路减压cage椎间植骨融合钛板内固定治疗55例(cage组),采用颈椎前路减压zero-p椎间植骨融合内固定治疗55例(zero-p组)。比较2组手术时间、术中出血量、住院时间,术后12个月JOA评分、NDI指数、颈椎曲度、颈椎节段高度及植骨融合率,术后1周、3个月吞咽困难发生例数。结果所有患者均获得(22.78±3.10)个月随访。2组手术时间、术中出血量、住院时间比较差异无统计学意义(P0.05)。2组术后12个月JOA评分、NDI指数、颈椎曲度、颈椎节段高度、植骨融合率差异无统计学意义(P0.05)。zero-p组术后1周、3个月吞咽困难发生例数少于cage组,差异有统计学意义(P0.05)。结论颈椎前路减压cage椎间植骨融合钛板内固定与zero-p椎间植骨融合内固定治疗单节段脊髓型颈椎病均可取得满意的临床疗效,但zero-p椎间植骨融合内固定术后吞咽困难发生的风险明显较低,其安全性更符合临床需要。     

ROI-C双嵌片自锁融合器在脊髓型颈椎病前路减压融合术中的应用

 目的 探讨ROI-C双嵌片自锁融合器在多节段脊髓型颈椎病前路减压融合术中的应用效果。方法 2010年3月至2013年9月采用颈椎前路减压融合术治疗多节段脊髓型颈椎病92例,男58例,女34例;年龄46~76,平均56.8岁。采用普通cage加钛板固定（cage+钛板组）52例,ROI-C双嵌片自锁融合器固定（ROI-C融合器组）40例。比较两组患者的术前情况、手术时间、术中出血量、手术前后椎间隙高度、颈椎Cobb角、植骨融合率、并发症发生率、手术前后日本骨科协会（Japanese Orthopedic Association,JOA）评分、颈痛及上肢疼痛视觉模拟评分（visual analogue scale,VAS）。结果 92例均获得随访,随访时间12~48个月,平均22个月。cage+钛板组及ROI-C融合器组椎间隙高度由术前（47.15±6.96） mm、（46.95±7.14） mm分别增加至术后3个月（79.06±6.67） mm、（78.80±6.85） mm;颈椎Cobb角由术前4.27°±11.15°、2.80°±10.81°分别增加至术后3个月9.29°±12.90°、8.57°±13.00°。ROI-C融合器组较cage+钛板组手术时间短、术中出血量小、术后并发症发生率低,两组差异有统计学意义。末次随访时ROI-C融合器组JOA评分从术前（9.32±1.74）分增加到（15.15±0.91）分,改善率75.82%±13.28%;cage+钛板组从术前（9.11±1.23）分增加到（15.29±1.07）分,改善率77.91%±14.14%。两组改善率的差异无统计学差异。两组的颈痛及上肢痛VAS评分均较术前明显降低,但组间比较差异无统计学意义。结论 应用ROI-C双嵌片自锁融合器与普通cage+钛板融合的颈前路减压融合术治疗多节段脊髓型颈椎病疗效相当,而采用 ROI-C双嵌片自锁融合器固定具有手术时间短、出血少、创伤小、并发症发生率低等优点。     

Design,biomechanical study,and clinical application of a new pterygo-shaped titanium mesh cage

Objective  

In recent years, Cage/SyCages or titanium mesh cages with interbody fusion have become a common surgical treatment for patients with cervical spondylosis and traumatic lesions. However, numerous complications have been reported, including hardware failure or breakage, which necessitate reoperation, and complications at the bone graft site. To improve upon the existing traditional titanium mesh cage, we designed a new pterygo-shaped titanium mesh cage (PTMC).