摘要
目的 比较颈椎前路减压融合术(anterior cervical discectomy and fusion,ACDF)应用3D打印钛合金骨小梁椎间融合器(3D printing act titanium cage,3D cage)和聚醚醚酮椎间融合器(poly ether ether ketone cage,PEEK cage)治疗单节段颈椎退行性疾病的临床疗效。方法 回顾性分析2019年12月至2022年12月于成都中医药大学附属医院骨科接受单节段ACDF手术的117例患者,其中研究组(3D cage,n=57),对照组(PEEK cage,n=60)。记录并比较两组基线资料、围手术期指标(手术时间、出血量、住院时间)、术前、术后各时间点(3月、1年、2年)的脊髓功能日本骨科学会评分(Japanese Orthopaedic Association Scores,JOA)、颈椎功能障碍指数(Neck Disability Index,NDI),及影像学参数C2-7cobb角、C2-7矢状位轴向距离(C2-7 sagittal vertical axis,c SVA)、融合节段椎间高度(disc height,DH)。结果 两组的术中出血量和住院时间无差异(P<0.001),研究组的手术时间少于对照组(t=-3.481,P<0.001)。两组患者的JOA评分和NDI评分随时间呈优化趋势(F_(JOA评分)=1386.234,P_(JOA评分)<0.01,F_(NDI评分)=1500.343,P_(NDI评分)<0.001),术后至术后2年都优于术前。C2-7cobb角在时间和cage类型之间存在交互作用(F=3.523,P=0.014),两组术后及术后3月的C2-7cobb角都大于术前,且术后的C2-7cobb角研究组大于对照组。两组的c SVA随时间存在变化趋势(F=70.153,P<0.001),术后及术后3月的c SVA小于术前。两组的DH随时间存在变化趋势(F=109.004,P<0.001),术后至末次随访的DH高于术前。术后3月研究组的融合率大于对照组(χ^(2)=4.308,P=0.038),术后1年至末次随访两组的融合率无差异(P>0.05)。两组并发症发病率不存在差异(χ^(2)=0.052,P=0.820),均未发生需翻修的严重并发症。结论 3D cage可显著缩短手术时间,并促进术后3个月的早期融合,但两种融合器在2年随访期的临床疗效与并发症发生率无显著差异。
Objective The purpose of this study is to compare the clinical efficacy of anterior cervical discectomy and fusion(ACDF)using a 3D-printed titanium trabecular interbody fusion cage(3D cage)and a polyether ether ketone(PEEK)interbody fusion cage in the treatment of single-level cervical degenerative diseases.Methods Retrospective analysis of 117 patients who underwent single-segment ACDF surgery in the Department of Orthopaedics,Affiliated Hospital of Chengdu University of Traditional Chinese Medicine,between December 2019 and December 2022,with n=57 in the study group(3D cage)and n=60 in the control group(PEEK cage).Baseline data,perioperative indices(operative time,bleeding,length of hospital stay),preoperative and postoperative time at each time(3 months,1 year,and 2 years)Japanese Orthopaedic Association Scores(JOA),Neck Disability Index(NDI),and the imaging parameters of C2-7cobb angle,C2-7 sagittal vertical axis(cSVA),Disc Height(DH).Results There was no difference in intraoperative bleeding and length of hospital stay between the two groups,and the operative time in the study group was less than that in the control group(t=-3.481,P<0.001).JOA and NDI tended to optimise over time in both groups(FJOA=1386.234,PJOA<0.01,FNDI=1500.343,PNDI<0.001),and were better than preoperative up to 2 years postoperatively.There was an interaction between time and cage type for the C2-7cobb angle(F=3.523,P=0.014),the C2-7cobb angle was greater than preoperative in both groups in the postoperative period and at 3 months postoperatively,and in the postoperative period it was greater in the study group than in the control group.There was a trend in cSVA over time in both groups(F=70.153,P<0.001),and cSVA was less than preoperative in the postoperative period and at 3 months postoperatively.There was a trend in DH over time in both groups(F=109.004,P<0.001),and DH was higher in the postoperative period to the last follow-up than in the preoperative period.The fusion rate was greater in the study group than in the control group at 3 months postoperatively(χ2=4.308,P=0.038),and there was no difference in the fusion rate between the two groups from 1 year postoperatively to the final follow-up(P>0.05).There was no difference in the incidence of complications between the two groups(χ2=0.052,P=0.820),and no serious complications requiring revision occurred in either group.Conclusion The 3D cage significantly reduced operative time and facilitated early fusion at 3 months postoperatively,but there was no significant difference in clinical efficacy and complication rates between the two fusion devices at the 2-year follow-up period.
作者
雷富豪
汪琨翔
杨涵翔
林可心
谢一舟
李统
余洋
LEI Fuhao;WANG Kunxiang;YANG Hanxiang;LIN Kexin;XIE Yizhou;LI Tong;YU Yang(Department of Orthopedics,Hospital of Chengdu University of Traditional Chinese Medicine,Chengdu 610000,China)
出处
《西南医科大学学报》
2025年第3期275-280,共6页
Journal of Southwest Medical University
基金
四川省自然科学基金项目青年基金(25QNJJ1102)。
关键词
3D打印
椎间融合器
颈椎前路减压融合术
颈椎病
3D Printing
Interbody fusion Cage
Anterior cervical discectomy and Fusion
Cervical spondylopathy
