传统钛网和3D打印人工椎体在单椎体颈椎前路椎体次全切除减压植骨融合术中应用的疗效比较

Comparison of the therapeutic effects of traditional titanium mesh and 3D printed artificial vertebral bodies in single segment anterior cervical corpectomy and fusion(ACCF)

中文关键词:  颈椎前路椎体次全切除减压植骨融合术  3D打印人工椎体  传统钛网  疗效对比

英文关键词:Anterior cervical corpectomy and fusion  3D printing of artificial vertebral bodies  Traditional titanium mesh  Comparison of therapeutic effects

中文摘要:

  【摘要】 目的：对比分析颈椎前路椎体次全切除减压植骨融合术（anterior cervical corpectomy and fusion，ACCF）中应用传统钛网和3D打印人工椎体的临床疗效。方法：回顾性分析2015年1月~2024年1月于本院行单椎体ACCF的42例脊髓型颈椎病患者，依据置入物种类不同分为传统钛网组（n=22，9例男性，13例女性，年龄60.6±10.0岁）和3D打印人工椎体组（n=20，10例男性，10例女性，年龄55.5±8.3岁）。两组患者年龄、性别、身体质量指数（body mass index，BMI）、累及节段等一般信息比较无统计学差异（P>0.05）。记录并比较两组患者的手术时间、术中出血量、住院时间等手术相关指标，术前、术后3d和术后1年的影像学参数（C2-7 Cobb角）、神经功能[日本骨科协会（Japanese Orthopaedic Association，JOA）评分和Nurick分级]、颈部疼痛视觉模拟量表（visual analogue scale，VAS）评分及颈椎功能障碍指数（neck disability index，NDI），以及术后cage沉降等并发症情况。结果：两组患者手术时间无明显差异（P＞0.05），3D打印人工椎体组术中出血量和术后住院时间显著低于传统钛网组（P<0.05）。术后各时间点两组JOA评分、Nurick分级、VAS评分、NDI评分均较术前明显改善；术前、术后3d和术后1年，两组患者JOA评分、Nurick分级、VAS评分、NDI评分均无明显差异。影像学测量分析可知，术后两组患者C2-7 Cobb角均有相应改善，术后3d、1年时3D打印人工椎体组优于传统钛网组（术后3d：20.2°±10.1° vs 13.8°±9.8°，P<0.05；术后1年：19.7°±10.2° vs 13.0°±9.7°，P<0.05）。传统钛网组患者出现1例cage沉降的情况，而3D打印人工椎体组在随访期间未发现有cage沉降。结论：在ACCF中，传统钛网和3D打印人工椎体均能有效治疗脊髓型颈椎病，显著改善患者症状，但应用3D打印人工椎体能显著减少术中出血量和患者术后住院天数。并且，3D打印人工椎体在维持颈椎生理结构方面更具优势。

英文摘要:

  【Abstract】 Objectives: To analyze and compare the clinical efficacy of traditional titanium mesh and three-dimensional(3D) printed artificial vertebral bodies in anterior cervical corpectomy and fusion(ACCF). Methods: A retrospective analysis was conducted on 42 patients with cervical spondylotic myelopathy who underwent single segment ACCF at our hospital from January 2015 to January 2024. The patients were divided into a traditional titanium mesh group(n=22, 9 males and 13 females, aged 60.6±10.0 years) and a 3D printed artificial vertebral body group(n=20, 10 males and 10 females, aged 55.5±8.3 years) based on the type of implant. There was no statistical difference between the two groups in age, gender, body mass index(BMI), as well as affected segments(P>0.05). The operative time, intraoperative blood loss, and length of hospital stay, as well as imaging parameters(C2-7 Cobb angle), neurological function[Japanese Orthopaedic Association(JOA) score and Nurick grading], neck pain visual analogue scale(VAS) score, and neck disability index(NDI) before operation, at postoperative 3d and 1 year were recoreded and compared between the two groups, meanwhile, the postoperative cage deposition and other complications were also analyzed and compared. Results: There was no significant difference in the operative time between the two groups of cases(P>0.05). The intraoperative blood loss and postoperative length of hospital stay of the 3D printed artificial vertebral body group were significantly lower than those in the traditional titanium mesh group(P<0.05). At each postoperative time point, both groups showed significant improvement in JOA scores, Nurick grading, VAS scores, and NDI scores compared to preoperative levels. However, there were no significant differences in JOA scores, Nurick grading, VAS scores, and NDI scores between the two groups of patients at preoperation, postoperative 3d, and postoperative 1 year. According to radiological measurement analysis, both groups of patients showed great improvement in the C2-7 Cobb angle after surgery, and 3D printed artificial vertebral body group was better than traditional titanium mesh group in C2-7 Cobb angle on postoperative 3d(20.2°±10.1° vs 13.8°±9.8°, P<0.05) and at 1 year follow-up(19.7°±10.2° vs 13.0°±9.7°, P<0.05). There was one case of cage settlement in the traditional titanium mesh group, while no cage settlement was found in the 3D printed artificial vertebral body group during follow-up. Conclusions: Both traditional titanium mesh and 3D printed artificial vertebral body in ACCF can effectively treat cervical spondylotic myelopathy and significantly improve patients′ symptoms. However, the application of 3D printed artificial vertebral bodies can significantly reduce intraoperative bleeding and postoperative hospitalization days for patients. Moreover, 3D printed artificial vertebral bodies have more advantages in maintaining the physiological structure of the cervical spine.