新型同种异体骨椎间融合器治疗颈椎病的临床应用

方青; 李洋; 武文杰; 刘勋; 许建中; 罗飞

doi:10.16016/j.1000-5404.201811083

您当前的位置：

首页 >

文章列表页 >

新型同种异体骨椎间融合器治疗颈椎病的临床应用

临床医学 | 更新时间：2026-01-09

- 新型同种异体骨椎间融合器治疗颈椎病的临床应用
- Clinical efficiency of a new allograft cervical cage in treatment of cervical spondylosis
- 第三军医大学学报 2019年41卷第9期页码：877-884
- 作者机构：
  
  400038 重庆，陆军军医大学(第三军医大学)第一附属医院骨科，全军矫形外科中心
- 作者简介：
  
  [罗飞，E-mail:luofly1009@hotmail.comLUO Fei, E-mail:luofly1009@hotmail.com
- 基金信息：
  
  西南医院临床医学创新基金(SWH2013LC23)
- DOI：10.16016/j.1000-5404.201811083
  中图分类号： R197.39;R681.55;R687.43
- 收稿：2018-11-12，
  
  修回：2019-01-10，
  
  纸质出版：2019-05-15
- 稿件说明：
移动端阅览
方青, 李洋, 武文杰, 等. 新型同种异体骨椎间融合器治疗颈椎病的临床应用[J]. 第三军医大学学报, 2019,41(9):877-884.

Qing FANG, Yang LI, Wenjie WU, et al. Clinical efficiency of a new allograft cervical cage in treatment of cervical spondylosis[J]. Journal of Third Military Medical University, 2019, 41(9): 877-884.
方青, 李洋, 武文杰, 等. 新型同种异体骨椎间融合器治疗颈椎病的临床应用[J]. 第三军医大学学报, 2019,41(9):877-884. DOI： 10.16016/j.1000-5404.201811083.

Qing FANG, Yang LI, Wenjie WU, et al. Clinical efficiency of a new allograft cervical cage in treatment of cervical spondylosis[J]. Journal of Third Military Medical University, 2019, 41(9): 877-884. DOI： 10.16016/j.1000-5404.201811083.

摘要

目的

评价新型同种异体骨椎间融合器治疗颈椎病的安全性和有效性，观察融合器下沉对术后功能改善的影响。

方法

回顾性分析我院2015年1月至2016年12月采用BioCage

融合器和PEEK融合器行单节段前路颈椎间盘摘除、椎间融合术(anterior cervical discectomy and fusion

ACDF)的颈椎病患者80例，通过颈椎正侧位X线片及CT评估颈椎曲度、椎间高度、融合器位置和融合情况。使用VAS和NDI评分评估临床症状的改善情况。观察新型同种异体骨椎间融合器的临床应用效果。

结果

43例单节段颈椎病患者采用BioCage

融合器行ACDF手术，男性29例，女性14例，平均年龄50.44(24~81)岁；37例患者采用PEEK融合器行ACDF手术，男性26例，女性11例，平均年龄49.31(24~78)岁；随访时间12~36(平均23.02)个月。Biocage

组和PEEK组随访中颈椎曲度较术前明显改善(

0.05)，椎间高度末次随访时虽有丢失，但仍较术前明显恢复(

0.05)。随访时患者VAS和NDI评分明显低于术前(

0.05)。术后即刻与术后1年融合器后缘到椎体后壁距离(D-PCW)比较差异无统计学意义(

0.05

)。术后两组融合器下沉高度及下沉发生率差异均无统计学意义(

0.05)。术后3个月，根据CT判断BioCage

组全部融合，融合率为100%(43/43)；PEEK组有1例未融合，融合率为97.30%(36/37)。术后6个月两组均全部融合。本组患者中共有17例术后出现融合器下沉，其中BioCage

组9例，PEEK组8例，VAS及NDI评分分别降低3.94(5.09~1.15)、26.87(35.34~8.47)，与未下沉患者VAS及NDI评分比较差异均无统计学意义(

0.05)。

结论

新型同种异体骨椎间融合器按国人颈椎解剖外形设计，终板骨性接触面积大，表面齿状突起可有效防止融合器的滑移，提供术后即刻稳定性，有利于恢复颈椎正常生理前凸，治疗单节段颈椎病具有较好的安全性和有效性。

Abstract

Objective

To evaluate the efficacy and reliability of a novel allograft cervical cage in treatment of cervical spondylosis

and observe the effect of subsidence on clinical outcome.

Methods

We retrospectively reviewed 80 cases with cervical spondylosis undergoing anterior cervical discectomy and fusion (ACDF) with BioCage

or PEEK cage in our department from January 2015 to December 2016. During follow-up

X-ray film (anterior-posterior and lateral) and computed tomography (CT) scan were used to assess segmental and overall cervical lordosis

intervertebral height

cage positioning

and final fusion state. Visual analog scale (VAS) and neck disability index (NDI) were calculated to evaluate clinical outcomes.

Results

There were 43 cases (29 males and 14 females

at a mean age of 50.44 years

ranging from 24 to 81) undergoing ACDF using Biocage

and 37 cases (26 males and 11 females

at a mean age of 49.31 years

ranging from 24 to 78) using PEEK cage. During the follow-up of 12 to 36 months (average 23.02 months)

the segmental and overall cervical lordosis were greatly improved in both groups (

0.05)

and the intervertebral height was also significantly better than that of pre-operation (

0.05) though having some loss in the last follow-up. The VAS score and NDI score were obviously reduced after operation (

0.05). No mi

gration or extrusion of the cage (by the distance from posterior edge of fusion cage to posterior vertebral body wall

D-PCW) was observed immediately after surgery and at the latest follow-up. There were no statistical differences in the height and occurrence of subsidence between the 2 kinds of fusion cages. In 3 months postoperatively

BioCage

group all achieved bone fusion according to the CT image

with a fusion rate of 100% (43/43)

while 1 case of PEEK group had not gotten fusion

with a fusion rate of 97.3% (36/37)

and this case achieved fusion in 6 months postoperatively. Among the 17 cases experiencing cage subsidence

9 were from the BioCage

group and 8 from the PEEK group. In these subsidence cases

their VAS and NDI scores were respectively reduced 3.94 (from 5.09 to 1.15) and 26.87 (from 35.34 to 8.47)

and the differences of VAS and NDI improvement was not statistically significant between those with and without cage subsidence (

0.05).

Conclusion

The novel cervical allograft cage (BioCage

) is designed according to the anatomical shape of Chinese cervical vertebra. Its large bone contact area of endplate and dentate processes on surface can effectively prevent the slip of the cage and provide immediate postoperative stability. At the same time

the cage facilitates the normal cervical lordosis

and has a good safety and effective adjunct to ACDF for the treatment of patients with cervical spondylosis.

关键词

Keywords

references

SMITH G W, ROBINSON R A. The treatment of certain cervical-spine disorders by anterior removal of the intervertebral disc and interbody fusion[J]. J Bone Joint Surg Am, 1958, 40-A(3): 607-624.

CHEN Y, WANG X W, LU X H, et al . Comparison of titanium and polyetheretherketone (PEEK) cages in the surgical treatment of multilevel cervical spondylotic myelopathy: A prospective, randomized, control study with over 7-year follow-up[J ] . Eur Spine J, 2013, 22(7): 1539-1546. DOI:10.1007/s00586-013-2772-y.

OFLUOGLU A E, ERDOGAN U, AYDOGAN M, et al . Anterior cervical fusion with interbody cage containing beta-tricalcium phosphate: Clinical and radiological results[J ] . Acta Orthop Traumatol Turc, 2017, 51(3): 197-200. DOI:10.1016/j.aott.2017.03.001.

CLOWARD R B. The anterior approach for removal of ruptured cervical disks[J]. J Neurosurg, 1958, 15(6): 602-617. DOI: 10.3171/jns.1958.15.6.0602.

ZDEBLICK T A, DUCKER T B. The use of freeze-dried allograft bone for anterior cervical fusions[J]. Spine(Phila Pa 1976), 1991, 16(7):726-729.DOI:10.1097/00007632-199107000-00006.

BAO D, MA Y Z, CHEN X, et al . Exploratory development of titanium mesh with bone allograft in treatment of cervical spinal tuberculosis[J ] . Chin J Surg, 2010, 48(2): 112-115.

SUCHOMEL P, BARSA P, BUCHVALD P, et al . Autologous versus allogenic bone grafts in instrumented anterior cervical discectomy and fusion: a prospective study with respect to boneunion pattern[J ] . Eur Spine J, 2004, 13(6): 510-515. DOI10.1007/s00586-003-0667-z.

GERCEK E, ARLET V, DELISLE J, et al . Subsidence of stand-alone cervical cages in anterior interbody fusion: warning[J ] . Eur Spine J, 2003, 12(5): 513-516.DOI: 10.1007/s00586-003-0539-6.

ARNOLD P M, ROBBINS S, PAULLUS W, et al . Clinical outcomes of lumbar degenerative disc disease treated with posterior lumbar interbody fusion allograft spacer: A prospective, multicenter trial with 2-year follow-up[J ] . Am J Orthop, 2009, 38(7): E115-E122.

KAO F C, NIU C C, CHEN L H, et al . Maintenance of interbody space in one- and two-level anterior cervical interbody fusion: comparison of the effectiveness of autograft, allograft, and cage[J ] . Clin Orthop Relat Res, 2005(430): 108-116.

BARSA P, SUCHOMEL P. Factors affecting sagittalmalalignment due to cage subsidence in standalone cage assisted anterior cervical fusion[J].Eur Spine J, 2007, 16(9): 1395-1400.DOI: 10.1007/s00586-006-0284-8.

BARTELS R H, DONK R D, FEUTH T. Subsidence of stand-alone cervical carbon fiber cages[J].Neurosurg, 2006, 58(3):502-508. DOI:10.1227/01.NEU.0000197258.30821.50.

KWON W K, KIM P S, AHN S Y, et al . Analysis of associating factors with C2-7 sagittal vertical axis after two-level anterior cervical fusion: comparison between plate augmentation and stand-alone cages[J ] . Spine, 2017, 42(5): 318-325. DOI:10.1097/BRS.0000000000001776.

HYUN S J, KIM K J, JAHNG T A, et al . Relationship between T1 slope and cervical alignment following multilevel posterior cervical fusion surgery: impact of T1 slope minus cervical lordosis[J ] . Spine, 2016, 41(7): E396-E402.DOI:10.1097/BRS.0000000000001264.

KULKARNI A G, HEE H T, WONG H K. Solis cage (PEEK) for anterior cervical fusion: preliminary radiological results with emphasis on fusion and subsidence[J]. Spine J, 2007, 7(2): 205-209. DOI:10.1016/j.spinee.2006.03.002.

OH H S, SHIM C S, KIM J S, et al . Clinical and radiological comparison of femur and fibular allografts for the treatment of cervical degenerative disc diseases[J ] . J Korean Neurosurg Soc, 2013, 53(1):6-12.DOI:10.3340/jkns.2013.53.1.6.

RAMNARAIN A, GOVENDER S. Fibular allograft and anterior plating for dislocations/fractures of the cervical spine[J]. Indian J Orthop, 2008, 42(1): 83-86.DOI: 10.4103/0019-5413.38587.

YUE W M, BRODNER W, HIGHLAND T R. Long-term results after anterior cervical discectomy and fusion with allograft and plating: A 5- to 11-year radiologic and clinical follow-up study[J]. Spine, 2005, 30(19): 2138-2144.

MARTIN G J Jr, HAID R W Jr, MACMILLAN M, et al . Anterior cervical discectomy with freeze-dried fibula allograft. Overview of 317 cases and literature review[J ] . Spine(Phila Pa 1976), 1999, 24(9): 852-858; discussion 858-859.

KAST E, DERAKHSHANI S, BOTHMANN M, et al . Subsidence after anterior cervical inter-body fusion. A randomized prospective clinical trial[J ] .Neurosurg Rev, 2009, 32(2): 207-214; discussion 214. DOI:10.1007/s10143-008-0168-y.

浏览量

下载量

CSCD

文章被引用时，请邮件提醒。

提交

工具集

关联资源

同种异体骨植骨联合锁定加压钢板治疗四肢良性骨肿瘤及类瘤病变的随访研究