颈椎前路减压3D打印椎间融合器融合内固定术对颈椎矢状位参数的影响

Effect of anterior cervical decompression and internal fixation on sagittal parameters of the cervical spine using 3D printed intervertebral fusion cage

中文关键词:  神经根型颈椎病  3D打印椎间融合器  矢状位平衡参数

英文关键词:Cervical spondylotic radiculopathy  3D printed intervertebral fusion cage  Sagittal balance parameters

中文摘要:

  【摘要】 目的：探究应用3D打印椎间融合器行椎间盘摘除减压融合内固定术对神经根型颈椎病患者矢状位平衡参数的影响。方法：回顾性分析2017年1月～2018年6月在我院行颈椎前路椎间盘切除减压融合内固定术（anterior cervical discectomy and fusion，ACDF）治疗的神经根型颈椎病患者76例，按照随机数字表法分为观察组（38例）和对照组（38例）。观察组男性21例，女性17例，年龄42～62岁，平均51.7±3.8岁，对照组男性20例，女性18例，年龄41～63岁，平均52.4±4.5岁。观察组置入3D打印椎间融合器，对照组置入普通异体骨块。比较两组手术情况（手术时间、术中失血量、住院天数）；在术前、术后即刻、术后6个月、术后1年颈椎正侧位X线片上测量并比较两组矢状位平衡参数（C2-7 Cobb角、C2-7 SVA、T1倾斜角）；比较两组患者术后6个月、术后1年颈椎功能（JOA）评分；术后1年通过颈椎侧位X线片评估融合情况并计算融合率；统计并比较两组并发症发生情况。结果：观察组术中失血量45.73±5.27ml，对照组62.15±7.38ml；观察组手术时间84.29±6.11min，对照组105.34±12.04min；观察组住院天数6.81±1.52d；对照组8.54±1.08d；两组间差异均有统计学意义（P＜0.05）。观察组术后即刻C2-7 Cobb角为26.15°±3.02°，C2-7 SVA为14.28±2.31mm，T1倾斜角为31.46°±1.83°；术后6个月时分别为28.79°±4.03°、12.60±4.24mm、30.16°±1.64°；术后1年分别为29.46°±5.11°、11.31±3.70mm、28.65°±2.02°；对照组术后即刻C2-7 Cobb角为21.67°±2.59°，C2-7 SVA为17.39±3.04mm，T1倾斜角32.78°±1.91°、术后6个月分别为23.76°±3.90°、16.88±3.29mm、31.58°±2.01°，术后1年分别为25.28°±4.43°、15.42±3.46mm、30.46°±1.79°，各时间点观察组均优于对照组（P＜0.05）。观察组术后6个月、术后1年JOA评分高于对照组（P＜0.05）；术后1年时，两组均获得100%融合率。观察组并发症发生率5.56%（2/36）与对照组11.76%（4/34）差异无统计学意义（P＞0.05）。结论：与置入普通异体骨块相比，3D打印椎间融合器应用于神经根型颈椎病患者临床效果良好，可纠正颈椎矢状位平衡，有利于颈椎功能的改善。

英文摘要:

  【Abstract】 Objectives: To explore the effect of 3D printed intervertebral fusion cage-assisteddiscectomy, decompression, fusion and internal fixationonpostoperativecervical sagittal balance parameters in patients with cervical spondylotic radiculopathy. Methods: A total of 76 patients with cervical spondylotic radiculopathy treated in our hospital from January 2017 to June 2018 were selected and divided into observation group (38 cases) and control group(38 cases) according to the table of random digits. There were 21 males and 17 females in the observation group , aged 42-62 years old, with an average of 51.7±3.8 years old, and 20 males and 18 females in the control group, aged 41-63 years old, with an average of 52.4±4.5 years old. Both groups were treated with intervertebral disc removal, decompression, fusion and internal fixation. Patients were implanted with ordinary allograft bone in the control group, and with 3D printed intervertebral fusion cage in the observation group . The operative conditions(operative time, intraoperative blood loss, length of stay) were compared between the two groups. The sagittal balance parameters (C2-7 Cobb angle, C2-7 SVA, T1 tilt angle) before operation, immediately after, 6 months after, and 1 year after surgery were compared between the two groups by anterior and lateral X-ray examination of cervical spine. Cervical spine function (JOA) scores of 6 months and 1 year after surgery were compared between the two groups. The fusion was evaluated by lateral radiographs of the cervical spine at 1 year postoperatively, and the fusion rate was calculated. The incidence of complications between the two groups was statistically compared. Results: Intraoperative blood loss was 45.73±5.27ml in the observation group and 62.15±7.38ml in the control group. In the observation group , the operative time was 84.29±6.11min, and the length of stay was 6.81±1.52 days. In the control group, the operative time was 105.34±12.04min, and the length of stay was 8.54±1.08 days. The differences between the two groups were statistically significant(P<0.05). In the observation group , the C2-7 Cobb angle was 26.15°±3.02°, the C2-7 SVA was 14.28±2.31mm, and the T1 tilt angle was 31.46°±1.83° immediately after surgery. They were 28.79°±4.03°, 12.60±4.24mm, 30.16°±1.64° at 6 months aftersurgery. They were 29.46°±5.11°, 11.31±3.70mm, 28.65°±2.02°, respectively, one year after surgery. In the control group, the C2-7 Cobb angle was 21.67°±2.59° immediately after surgery, the C2-7 SVA was 17.39±3.04mm, the T1 tilt angle was 32.78°±1.91°, and the 6 months after surgery were 23.76°±3.90°, 16.88±3.29mm, 31.58°±2.01°, respectively. One year aftersurgery, they were 25.28°±4.43°, 15.42±3.46mm and 30.46°±1.79°, respectively. The parameters of the observation group were better than those of the control group at each time point(P<0.05). The JOA scores of the observation group at 6 months and 1 year after surgery were higher than those of the control group(P<0.05). At one year aftersurgery, the fusion rates of both groups were 100%, and the complication rate of the observation group was 5.56%(2/36), and that of the control group was 11.76%(4/34), with no statistical significance(P＞0.05). Conclusions: Compared with the implantation of ordinary allogeneic bone blocks, the application of 3D printed intervertebral fusion cages in patients with cervical spondylotic radiculopathy can optimize the operation situation during the decompression, adjust significantlythe sagittal balance of cervical spine and improve the function of cervical spine.