CAJ | 학술논문

目的：探讨使用终板环对颈椎前路椎体次全切除植骨融合术后钛网沉陷及临床效果的影响。方法：对2008年2月至2011年2月采用颈椎前路椎体次全切除植骨融合术治疗的71例脊髓型颈椎病患者进行回顾性分析，男38例，女33例；年龄39～74岁，平均53．8岁。根据术中是否使用终板环将71例患者分为终板环使用组（33例）及无终板环使用组（38例）。比较两组手术前后的影像学资料及临床疗效。影像学评价指标为融合节段前凸角度（Cobb角）及融合节段椎体间前缘高度（Da）、后缘高度（Dp）及平均高度（Dm），用以评估钛网沉陷情况；临床疗效评价指标为JOA评分，观察改善率，并记录术后症状及Odom分级。结果：71例患者的随访时间为13～34个月，平均19．5个月。影像学评价：两组患者术前及术后1周融合节段Cobb角、平均椎体间高度差异均无统计学意义（P＞0．05）。术后1年，融合节段Cobb角终板环使用组为（9．4±3．8）°，无终板环使用组为（7．5±3．9）°，差异有统计学意义（P＜0．05）；Dm终板环使用组为（57．3±2．2） mm，无终板环使用组为（55．2±2．6） mm，差异有统计学意义（P＜0．05）；沉陷的发生率终板环组为57．6％，无终板环使用组为78．9％，差异有统计学意义（P＜0．05）。临床疗效评价：两组患者术前术后在JOA评分及改善率上差异均无统计学意义（P＞0．05）。术后1年，90．9％的终板环使用组患者及89．5％的无终板环使用组患者Odom评分获得很好或较好结果。结论：终板环的使用可在一定程度上降低钛网沉陷的发生率及其程度。
목적：탐토사용종판배대경추전로추체차전절제식골융합술후태망침함급림상효과적영향。방법：대2008년2월지2011년2월채용경추전로추체차전절제식골융합술치료적71례척수형경추병환자진행회고성분석，남38례，녀33례；년령39～74세，평균53．8세。근거술중시부사용종판배장71례환자분위종판배사용조（33례）급무종판배사용조（38례）。비교량조수술전후적영상학자료급림상료효。영상학평개지표위융합절단전철각도（Cobb각）급융합절단추체간전연고도（Da）、후연고도（Dp）급평균고도（Dm），용이평고태망침함정황；림상료효평개지표위JOA평분，관찰개선솔，병기록술후증상급Odom분급。결과：71례환자적수방시간위13～34개월，평균19．5개월。영상학평개：량조환자술전급술후1주융합절단Cobb각、평균추체간고도차이균무통계학의의（P＞0．05）。술후1년，융합절단Cobb각종판배사용조위（9．4±3．8）°，무종판배사용조위（7．5±3．9）°，차이유통계학의의（P＜0．05）；Dm종판배사용조위（57．3±2．2） mm，무종판배사용조위（55．2±2．6） mm，차이유통계학의의（P＜0．05）；침함적발생솔종판배조위57．6％，무종판배사용조위78．9％，차이유통계학의의（P＜0．05）。림상료효평개：량조환자술전술후재JOA평분급개선솔상차이균무통계학의의（P＞0．05）。술후1년，90．9％적종판배사용조환자급89．5％적무종판배사용조환자Odom평분획득흔호혹교호결과。결론：종판배적사용가재일정정도상강저태망침함적발생솔급기정도。
Objective:To evaluate the clinical results of using end plate rings in preventing subsidence of titanium cage in anterior cervical corpectomy and fusion (ACCF) surgery. Methods:The clinical data of 71 patients with cervical spondylotic myelopathy underwent ACCF in single segment from February 2008 to February 2011 were retrospectively analyzed. There were 38 males and 33 females,aged from 39 to 74 years old with a mean of 53.8 years. Thirty three were used end plate rings and thirty eight were not used (end plate rings group and no end plate ring group,respectively). The Japanese Orthopaedic Association (JOA) score,Odom's scale,imaging data were used to evaluate the clinical effects. Imaging data including Cobb angle of fusion segment ,intervertebral height of anterior border (Da) and posterior border (Dp),the mean intervertebral height (Dm). Results:All patients were followed up from 13 to 34 months with an average of 19.5 months. Between two groups,there was no significant difference in Cobb angle of fusion segment and the mean intervertebral height (Dm) before surgery and one week after surgery. Whereas,one year after surgery,the Cobb angle of end plate ring group was(9.4±3.8)°,and contral group was (7.5±3.9)°,which was significantly lower than that of end plate ring group. Meanwhile,the Dm of end plate ring group was (57.3±2.2) mm,and no end ring group was (55.2±2.6) mm which was significantly lower than that of end plate ring group. The subsidence in end plate ring group was 57.6%,and was 78.9%in no end plate ring group. There was no signifi-cant difference in JOA score before and after surgery between two groups. At 1 year after operation ,90.9%(30/33) got excel-lent or good results in end plate ring group,89.5%(33/38) got excellent or good results in contral group. Conclusion:The use of end plate rings could not completely prevent the subsidence of titanium cage ,however,which can decrease the occurrence rate of the subsidence and lessen its degree.