钛网置入位置对三节段颈椎病颈前路混合减压融合术后效果的影像学研究

Imaging study of mesh placement on the postoperative effects of hybrid decompression and fixation for 3-level cervical spondylotic myelopathy

中文关键词:  颈椎病  三节段  混合减压融合术  内固定  钛网沉降

英文关键词:Cervical spondylotic myelopathy  3－level  Hybrid decompression and fusion  Internal fixation  Titanium mesh subsidence

中文摘要:

  【摘要】 目的：探讨三节段颈椎病患者颈前路混合减压融合术钛网放置位置对术后钛网沉降的影响。方法：2016年9月~2020年9月在我院脊柱外科行颈前路混合减压融合术并获得完整随访的三节段颈椎病患者58例，根据钛网与椎间融合器的相对位置分为A组（钛网置入近端节段，32例）和B组（钛网置入远端节段，26例）。收集两组患者的一般资料（性别、年龄、病程、手术节段、手术时间、出血量及术后随访时间），并对患者术前、术后即刻、术后2个月以及末次随访时的钛网置入节段椎间高度、融合节段Cobb角以及C2-7 Cobb角等影像学数据进行测量和统计学比较。结果：两组患者性别、年龄、病程、手术节段、手术时间、出血量及术后随访时间均无显著性差异（P>0.05）。两组患者术后即刻置入钛网的椎间高度无统计学差异（27.75±2.79mm vs 28.46±2.11mm，P>0.05）；A组患者术后2个月及末次随访时的钛网置入节段椎间高度分别为25.66±2.80mm和24.47±2.50mm，B组为26.76±2.13mm和25.73±2.57mm，两组同时间点比较有显著性差异（P＜0.05）。B组患者术后2个月及末次随访时的钛网沉降分别为3.61±1.25mm和1.09±0.67mm，显著性大于A组的2.33±0.61mm和1.00±0.53mm（P<0.05）。两组患者术后2个月及末次随访时融合节段Cobb角较术后即刻均有显著性下降（P＜0.05），两组间术后即刻、术后2个月及末次随访时融合节段Cobb角均无显著性差异（P>0.05）。术后即刻两组患者C2-7 Cobb角均得到纠正，术后2个月及末次随访时C2-7 Cobb角与术后即刻比较均有显著性丢失（P<0.05），两组患者同时间点C2-7 Cobb角下降均无统计学差异（P＞0.05）。A组4例患者术后2个月即观察到内固定松动及移位，B组患者术后随访时未观察到明显钢板或螺钉松动及移位。结论：三节段颈椎病行颈前路混合减压融合术钛网置入远端节段时发生钛网沉降的程度更大。

英文摘要:

  【Abstract】 Objectives: To explore the location effects of mesh placement on postoperative subsidence in patients with 3-level cervical spondylotic myelopathy undergone hybrid decompression and fusion(HDF). Methods: 58 cases with 3-level cervical spondylotic myelopathy undergone HDF from September 2016 to September 2020 admitted to the spinal surgery department of our hospital were divided into group A(titanium mesh located at the cephalad end, n=32) and group B(titanium mesh located at the caudal end n=26). The general conditions(gender, age, course of disease, operative segment, operative time, intraoperative bleeding, and postoperative follow-up time) of the patients in the two groups were collected. The imaging data of intervertebral height of mesh located segment, fused segment Cobb angle, and C2-7 Cobb angle before surgery on the day right after surgery, at 2 months after surgery, and the last follow-up were measured and compared. Results: There were no significant differences between the two groups in terms of the general conditions（P>0.05）. The intervertebral height of mesh located segment immediately after operation between groups showed no significant difference(27.75±2.79mm vs 28.46±2.11mm，P>0.05), which was 25.66±2.80mm and 24.47±2.50mm of group A vs 26.76±2.13mm and 25.73±2.57mm of group B, respectively, at 2 months after operation and the final follow-up, with significant differences at the same time point(P<0.05). The titanium mesh subsidence values at 2 months and the last follow-up were 3.61±1.25mm and 1.09±0.67mm in group B, respectively, which were higher than those in group A of 2.33±0.61mm and 1.00±0.53mm(P<0.05). The fused segment Cobb angles decreased in both groups at 2 months postoperatively and the final follow-up compared with those immediately after operation(P>0.05). However, there was no significant difference in the fused segment Cobb angle between the two groups immediately after surgery, at 2 months after surgery, and at the last follow-up(P>0.05). The C2-7 Cobb angles were corrected in both groups immediately postoperatively, and all patients had significant decreases in C2-7 Cobb angles at 2 months postoperatively and the final follow-up(P<0.05), but there was no significant difference in the decreases in C2-7 Cobb angle between the two groups at the same time point(P>0.05). Loosening and displacement of the internal fixation were observed in four patients in group A at 2 months postoperatively but none in group B. Conclusions: The probability of mesh subsidence was higher when the mesh was placed caudally in patients with 3-level cervical spondylotic myelopathy undergone hybrid decompression and fusion.