摘要
目的观察3D打印微孔钛合金人工椎体治疗颈椎后纵韧带骨化症的临床疗效。方法回顾性分析本院脊柱科2018年1月至2020年1月行颈前路椎体次全切除减压、3D打印微孔钛合金人工椎体植入或钛网植入、钛板内固定术的64例颈椎后纵韧带骨化症患者临床资料,根据纳入排除标准最终纳入57例。按内植物的不同分为观察组(内植物为3D打印人工椎体,28例)及对照组(内植物为钛网,29例)。对比两组手术时间、术中出血量、JOA评分与改善率及术后假体沉降发生率、植骨融合情况。结果观察组手术时间(59.32±12.09)min,术中出血量(102.75±11.25)mL;对照组手术时间(67.55±4.71)min,术中出血量(102.06±13.83)mL。观察组手术时间显著短于对照组(P=0.001)。两组术中出血量差异无统计学意义。随访12~15(14.3±2.7)个月,1例(对照组)出现伤口感染;术后出现颈部吞咽不适症状7例(观察组3例、对照组4例),1~2周后消失。末次随访时均骨性愈合,无内植物断裂、移位发生。观察组JOA评分由术前的(11.61±0.99)分提高至(16.10±0.68)分,改善率为(83.03±12.68)%;对照组JOA评分由术前的(11.37±1.08)分提高至(16.03±0.56)分,改善率为(81.58±12.67)%,两组改善率差异无统计学意义。假体沉降发生率观察组1例(3.57%),对照组12例(41.38%),两组间对比差异有统计学意义(P=0.001)。结论采用3D打印人工椎体能够重建颈椎的稳定性,与钛网相对比具有更好的骨-材料结合界面,且手术时间短,假体沉降发生率低。
Objective To observe the clinical efficacy of 3 D printed microporous titanium artificial vertebral body in the treatment of ossification of posterior longitudinal ligament(OPLL).Methods The clinical data of 64 patients with OPLL who underwent anterior subtotal vertebral resection and decompression followed by 3 D printed microporous titanium artificial vertebral body or titanium mesh cage implantation and titanium plate internal fixation in our department from January of 2018 to January of 2020 were collected and retrospectively analyzed.Finally,only 57 cases meeting the inclusion and exclusion criteria were recruited.According to different implants,they were divided into observation group(n=28,of 3 D printed microporous titanium artificial vertebral body)and control group(n=29,titanium mesh cage).The operation time,intraoperative blood loss,Japanese Orthopaedic Association(JOA)score and improvement rate,as well as incidence of prosthesis settlement and bone graft fusion were compared between the 2 groups.Results The operation time and intraoperative blood loss in the treatment group were 59.32±12.09 min and 102.75±11.25 mL respectively,while those in the control group was 67.55±4.71 min and 102.06±13.83 mL respectively.The operation time was significantly shorter in the observation group than the control group(P=0.001),but there was no statistical difference in intraoperative blood loss between them.During the follow-up time from 12 to 15(14.3±2.7)months,1 case(control group)complicated with wound infection,and 7 cases(3 cases in the treatment group and 4 cases in the control group)complicated with neck swallowing discomfort,which disappeared in 1~2 weeks later.All patients were bone healing at the last follow-up,and no fracture or malposition of implants were seen in all patients.At the last follow-up,the treatment group had a JOA score increased from 11.61±0.99 to 16.10±0.68,and an improvement rate of(83.03±12.68)%,and that in the control group was elevated from 11.37±1.08 to 16.03±0.56,and an improvement rate was(81.58±12.67)%.However,there was no significant difference in the improvement rate between the 2 groups.Significant difference was seen in prosthesis settlement between the treatment group(1 case,3.57%)and the control group(12 cases,41.38%,P=0.001).Conclusion 3 D printed microporous titanium artificial vertebral body can reconstruct the stability of cervical spine,with the advantages of better bone material interface,faster installation,and less prosthesis sinking when compared with titanium mesh cage.
作者
李玉伟
王海蛟
崔巍
胡冰涛
李凡
杨恬甜
LI Yuwei;WANG Haijiao;CUI Wei;HU Bingtao;LI Fan;YANG Tiantian(Department of Spine Surgery,Luohe Central Hospital,Luohe,Henan Province,462000,China)
出处
《陆军军医大学学报》
CAS
CSCD
北大核心
2022年第15期1542-1548,共7页
Journal of Army Medical University
关键词
颈椎
后纵韧带骨化症
3D打印微孔钛金属人工椎体
钛网
cervical spine
ossification of posterior longitudinal ligament
3D printed microporous titanium artificial vertebral body
titanium mesh cage
