干旱区生态环境知识资源中心(Arid): 颈椎椎间融合器翻修术

Arid

	颈椎椎间融合器翻修术
其他题名	Revision of caged cervical intervertebral fusion
	谢宁; 谭军; 沈康平; 刘铁龙; 陈德玉; 叶晓健; 贾连顺
来源期刊	中华骨科杂志
ISSN	0253-2352
出版年	2003
卷号	23 期号:9 页码:558-561
中文摘要	目的　分析颈椎椎间融合器(以下简称Cage)手术失败的原因，探讨颈椎Cage翻修手术的适应证、手术方式和手术效果。方法　颈椎Cage翻修术27例，其中颈椎间盘突出症4例，神经根型颈椎病2型，脊髓型颈椎病21例；单节段Cage8例，双节段15例，三节段4例。就诊时距原手术时间2～25个月，平均10.3个月。患者表现为颈肩部不适22例，颈肩部疼痛9例，脊髓压迫症状19例，术前JOA评分平均11.6分。翻修术前颈椎曲度较原手术后当时平均丢失7.1mm、椎间高度平均丢失3.9mm，24例出现颈椎后凸畸形，多节段者均出现两个Cage交错咬合现象，植骨不愈合6例，动态X线片显示颈椎不稳9例，CT或MRI显示减压节段仍存在压迫19例。对23例(29个Cage)行前路Cage取出减压、矫形固定。结果　全部病例随访4～26个月，平均11.7个月。较翻修术前颈肩部症状改善率为81%，脊髓压迫症状改善率为58%，术后JOA评分平均14.2分。前路翻修中17例植骨块于术后3个月时愈合，6例延迟愈合。颈椎后凸畸形消失，椎间高度平均增加3mm。未出现神经损伤和内固定失败病例。结论　Cage手术失败原因包括减压不够彻底、Cage沉陷产生颈椎曲度的丢失和植骨不愈合。翻修的适应证为神经症状进行性加重或出现颈椎不稳、畸形者。翻修时尽量采用前入路。取出Cage，彻底减压，植骨固定。注意保留原有骨质和颈椎的活动节段，长节段融合时应加后路固定。
英文摘要	Objective To probe the reasons of failure of caged cervical intervertebral fusion and define the indications, operative techniques and short term results of the revision surgery. Methods Twenty-seven cases of caged cervical fusion were revised. The indication for fusion was cervical disc herniation in four cases and cervical spondylotic mylopathy in 23 cases. Of the 27 cases, there were 8 single levels, 15 double levels, 4 three levels. The intervals from revision to primary fusion were 2-25 months, 10.3 months in average. Patients presented discomfort (22 cases) and local pain of neck and shoulder (9 cases) or paralysis (19 oases) preoperatively. JOA grade was mean 11.6 points before revision. Radiographic examination showed the mean lordosis loss was 7.1 mm, the mean interbody height loss was 3.9 mm. 24 patients presented kyphosis. Occluded neighboring cages were found in multilevel cases. Nonunion was founded in 6 cases, unstable in 9 cases, compression still existed in 19 cases. Removal of cages and then decompression, bone grafting and anterior plating fixation were performed in 23 cases (29 cages). 16 patients underwent further posterior fixation. Posterior revisions underwent in another 4 cases (9 cages), including laminectomy and re-shaping the lordosis and lateral mass screw plating fixation. Results All the cases were followed-up from 4 to 26 months, 11.7 months in average. The local symptoms released in 81% patients. Nerural deficit symptoms improved in 58% patients. Mean JOA grade was 14.2 points after revision. In 23 cases of anterior ap-proach revisions, 17 cases obtained bone healing within 3 months, while 6 cases got delayed union. The kyphosis was corrected, and the intervertebral height increased 3 mm in average. There were no nerural im-paction or failed internal fixation. Conclusion Deficient decompression, sinking of the cage into the can-cellous bone of the vertebral body and subsequent kyphosis and bone graft nonunion consist of the main causes for revision surgery. The indications of revision are aggressive neurologic symptom, unstable or deformity of the cervical spine. Cage removal, completely decompression, bone grafting and secure fixation are major steps of revision procedure. In case of more than 3 fusion levels, further posterior fixation is advised.
中文关键词	颈椎 ; 脊柱融合术 ; 内固定器 ; 再手术
英文关键词	Cervical vertebrae spinal fusion internal fixators Reoperation
语种	中文
国家	中国
收录类别	CSCD
WOS类目	SURGERY
WOS研究方向	Surgery
CSCD记录号	CSCD:1260276
资源类型	期刊论文
条目标识符	http://119.78.100.177/qdio/handle/2XILL650/204720
作者单位	第二军医大学附属长征医院骨科, 上海 200003, 中国
推荐引用方式 GB/T 7714	谢宁,谭军,沈康平,等. 颈椎椎间融合器翻修术[J],2003,23(9):558-561.
APA	谢宁.,谭军.,沈康平.,刘铁龙.,陈德玉.,...&贾连顺.(2003).颈椎椎间融合器翻修术.中华骨科杂志,23(9),558-561.
MLA	谢宁,et al."颈椎椎间融合器翻修术".中华骨科杂志 23.9(2003):558-561.