单节段颈椎椎体次全切除钛笼植骨融合术后钛笼下沉相关危险因素分析

Analysis of the risk factors of titanium mesh cage subsidence after the single level anterior cervical corpectomy and fusion

中文关键词:  颈椎椎体次全切除术  并发症  钛笼下沉  危险因素

英文关键词:Anterior cervical corpectomy and fusion  Titanium mesh cage subsidence  Complication  Risk factors

中文摘要:

  【摘要】 目的：分析单节段应用钛笼植骨的颈椎椎体次全切除融合术（anterior cervical corpectomy and fusion，ACCF）术后钛笼下沉的相关危险因素。方法：统计并回顾性分析我院2014年7月~2016年6月间应用钛笼植骨的单节段ACCF的44例患者临床资料，测量术前、术后3d内和术后3个月复查时所拍摄的颈椎X线平片，根据术后3个月随访时融合节段高度与术后3d内融合节段相比高度变化，将患者分为下沉组（高度丢失＞2mm）与未下沉组（高度丢失≤2mm），测量并分析两组间撑开角、钛笼倾斜角、钛笼深度、钉板夹角之间是否存在统计学差异，并通过Logistic回归分析分析钛笼下沉的危险因素。结果：术后3个月随访时，17例（38.64%）患者纳入未下沉组（高度丢失≤2mm），27例（61.36%）患者纳入下沉组（高度丢失＞2mm）。下沉组与未下沉组之间钛笼倾斜角、钛笼深度、钉板夹角差异有统计学意义（P<0.05），撑开角差异无统计学意义（P>0.05）。多因素Logistic回归分析结果提示，钛笼倾斜角增加是钛笼下沉的危险因素[95%置信区间（1.065，1.374），P<0.05]。结论：钛笼下沉为ACCF术后常见的现象。钛笼倾斜角为钛笼下沉的独立危险因素，若该角度＞8.6°将增加钛笼下沉的风险。

英文摘要:

  【Abstract】 Objectives: To investigate the risk factors of titanium mesh cage subsidence after one level anterior cervical corpectomy and fusion(ACCF). Methods: 44 patients underwent ACCF from July 2014 to June 2016. Each patient was taken the preoperative and postoperative (3d, 3m) X-ray respectively. According to the height of anterior border, the patients were divided into two groups, subsidence group(height loss more than 2mm) and non-subsidence group(height loss less than 2mm). These factors were divided into consideration including: Cobb angle, the tilt angle of cage implacement, the depth of cage implacement, the angle between screw and plate. Results: Titanium mesh cage subsidence occured in 27(61.36%) patients of non-subsidence group and 17(38.64%) patients of subsidence group after 3 months. The tilt angle of cage placement, the depth of cage placement, the angle between screw and plate showed difference between the two groups(P＜0.05). Multivariate logistic regression analysis showed that the tilt angle of cage placement was the risk factor[95%CI (1.065，1.374), P<0.05]. Conclusions: The titanium mesh cage subsidence is common after anterior cervical corpectomy and fusion. The tilt angle of cage placement is the risk factor that influnces titanium mesh cage subsidence. The risk of the TMC subsidence will be increased if the angle ＞8.6°.