CAJ | 학술논문

背景:颈椎前路钢板能最大程度地恢复椎间隙高度,扩大椎间孔,恢复颈椎的生理性前凸,同时能够预防单纯植骨时植骨面微小活动所带来的不稳定性,增加植骨融合率.但在应用颈椎前路钢板时,仍存在不同植骨物的选择:是取整块自体骨?还是运用钛网植骨?目的:分析比较3种不同颈椎前路融合植骨相关并发症的发生情况.方法:选择92例因颈椎间盘突出导致脊髓型颈椎病而行颈椎前路减压植骨的患者,均获得随访3个月以上.所有患者均行颈椎前路减压:6例行单纯植骨,21例行椎体间自体髂骨植骨内固定(Robinson植骨),65例行椎体间钛网植骨融合内固定.观察3种不同颈椎前路融合植骨相关并发症情况.结果与结论:6例单纯植骨患者中2例发生植骨块脱出,1例发生融合节段假关节形成,1例发生髂骨供区疼痛;21例椎体间自体髂骨植骨内固定患者中6例发生椎间高度丢失,3例发生髂骨供区疼痛;65例椎体间钛网植骨融合内固定患者中11例发生内植物下沉,椎间高度丢失,1例发生内固定断裂.结果显示单纯植骨因外固定时间长、并发症多目前较少使用;自体髂骨植骨内固定存在植骨吸收和供区并发症的缺点;椎体间钛网植骨融合内固定解决了供区并发症的问题,但仍存在钛网下沉、椎间高度丢失的缺点,术后6-9个月椎间高度丢失无明显增加,已获得椎间融合,多数患者无明显不适,不需要特别处理,由于它能从根本解决植骨供区并发症的问题,因此提倡使用钛网植骨内固定进行颈椎前路减压后的重建,但要注意适应证的选择和规范的操作.
배경:경추전로강판능최대정도지회복추간극고도,확대추간공,회복경추적생이성전철,동시능구예방단순식골시식골면미소활동소대래적불은정성,증가식골융합솔.단재응용경추전로강판시,잉존재불동식골물적선택:시취정괴자체골?환시운용태망식골?목적:분석비교3충불동경추전로융합식골상관병발증적발생정황.방법:선택92례인경추간반돌출도치척수형경추병이행경추전로감압식골적환자,균획득수방3개월이상.소유환자균행경추전로감압:6례행단순식골,21례행추체간자체가골식골내고정(Robinson식골),65례행추체간태망식골융합내고정.관찰3충불동경추전로융합식골상관병발증정황.결과여결론:6례단순식골환자중2례발생식골괴탈출,1례발생융합절단가관절형성,1례발생가골공구동통;21례추체간자체가골식골내고정환자중6례발생추간고도주실,3례발생가골공구동통;65례추체간태망식골융합내고정환자중11례발생내식물하침,추간고도주실,1례발생내고정단렬.결과현시단순식골인외고정시간장、병발증다목전교소사용;자체가골식골내고정존재식골흡수화공구병발증적결점;추체간태망식골융합내고정해결료공구병발증적문제,단잉존재태망하침、추간고도주실적결점,술후6-9개월추간고도주실무명현증가,이획득추간융합,다수환자무명현불괄,불수요특별처리,유우타능종근본해결식골공구병발증적문제,인차제창사용태망식골내고정진행경추전로감압후적중건,단요주의괄응증적선택화규범적조작.
BACKGROUND:Anterior cervical plate can maximize the intervertebral space height,expand intervertebral foramen,restore cervical physiological antecurvature,prevent instability due to implant micromovement,and increase graft fusion.However,the selection of entire autologous bone or Ti-mesh bone graft remains uncertain in application of anterior cervical plate.OBJECTIVE:To compare the complications of three different intervertebral fusion methods in anterior cervical decompression surgery.METHODS:A total of 92 cases of cervical spondylotic myelopathy were treated by anterior cervical decompression and three different intervertebral fusion methods.They were followed up for at least 3 months.Of them,6 underwent bone grafting alone,21 underwent autogenous bone graft with cervical plate-screw fixation,and 65 underwent pyramesh with anterior cervical plate-screw fixation.Complications were observed in all cases.RESULTS AND CONCLUSLON:A total of 2 of 6 autogenous bone grafting cases suffered from graft bone dislocation,1 suffered from pseudoarthrosis formation,and 1 suffered from donated ilium.Six of 21 autogenous bone graft with cervical plate-screw fixation suffered from loss of intervertebral height,and 3 suffered from pain of donated ilium.Eleven of 65 pyramesh with anterior cervical plate-screw fixation suffered from titanium mesh subsidence,1 case suffered from breakage of fixation screw.Simple autogenous bone grafting surgery was rarely used due to long duration of external fixation and too much complications.Autogenous bone grafting with anterior cervical plate-screw fixation surgery has shortage of grafted bone absorption and pain of donated ilium.Pyramesh with anterior cervical plate-screw fixation surgery overcomes the shortage of donated iliac pain,but remains the shortage of titanium mesh subsidence and lose of intervertebral height.