3D printed porous titanium alloy fusion cage and autologous iliac bone in the treatment of cervical spondylotic myelopathy

doi:10.12307/2022.687

Abstract

Abstract: BACKGROUND: The most commonly used bone graft material for anterior cervical fusion surgery is autologous iliac bone, but the incidence of complications is high. In recent years, 3D printed fusion cages have become an ideal bone graft material for anterior cervical surgery because of their large contact area, good mechanical properties and biocompatibility, and elastic modulus similar to that of a vertebral body.
OBJECTIVE: To compare the effect of 3D printed porous titanium trabecular bone fusion cage and autologous iliac bone in treating cervical spondylotic myelopathy.
METHODS: From January 2011 to January 2020, sixty-five patients with cervical spondylotic myelopathy (38 males and 27 females) underwent anterior decompression and fusion in the Guizhou Orthopedic Hospital. Twenty-eight cases were treated with 3D printing titanium trabecular fusion and plate internal fixation (trial group). Another 37 cases were treated with autogenous iliac bone graft and internal fixation (control group). At 1, 3, 6, and 12 months after surgery, the Japanese Orthopaedic Association (JOA) score, the height of the fusion segment, and the Cobb angle of the fusion segment were evaluated.
RESULTS AND CONCLUSION: (1) After 12-month follow-up, the incisions in the two groups of patients healed in the first intention. There were three and two cases of throat pain and dysphagia in the trial group and the control group after surgery, respectively. There were no internal fixation complications such as plate breakage, cage withdrawal, or subsidence. In the control group, three cases affected bone graft subsidence. (2) All 65 cases completed bony fusion within 6-9 months. There was no significant difference in JOA score, intervertebral height, and segment Cobb angle between the two groups (P > 0.05). (3) It is concluded that during anterior cervical interbody fusion for the treatment of cervical spondylotic myelopathy, 3D printed fusion cages and autogenous iliac bone grafts have achieved good results.

Key words: cervical spondylosis, titanium alloy brabeculae, autogenous iliac bone, bone graft fusion, anterior cervical interbody fusion, intervertebral space height, cervical curvature

CLC Number:

Ji Linsong, Wang Yanping, Lu tingsheng, Jia Yijia, Luo Chunshan. 3D printed porous titanium alloy fusion cage and autologous iliac bone in the treatment of cervical spondylotic myelopathy[J]. Chinese Journal of Tissue Engineering Research, 2022, 26(18): 2817-2822.

Figures/Tables 4

2.5 两组患者影像学测量指标的比较使用Shapiro-Wilk test对两组手术前后的融合节段高度数据做正态性检验，结果显示融合节段高度数据均服从正态分布(P > 0.05)。使用Mauchly’s 球形检验分析变量的协方差矩阵是否相等，发现不同时间点的融合节段高度满足球形检验(χ2=16.270，P=0.062)、不同分组的融合节段高度满足球形检验(χ2=0.000，P=1.000)、不同时间点和测量组的交互不满足球形检验(χ2=18.454，P=0.031)，采用Greenhouse-Geisser统计量对结果进行校正。采用重复测量设计方差分析对两组手术前后的融合节段高度做差异性比较，结果显示：组间融合节段高度比较差异无显著性意义(F=3.061，P=0.092)，各时间点间融合节段高度比较差异有显著性意义(F=37.628，P < 0.001)，组别×时间点的交互项的融合节段高度比较差异无显著性意义(F=1.401，P=0.239)；而当交互作用无统计学意义差异时，可单独分析主效应的意义，不需将每组拆分。采用LSD两两比较法分析不同测量时间点的差异，结果显示，术后各时间点的融合节段高度均高于术前(P < 0.05)，术后3，6，12个月的融合节段高度低于术后1个月(P < 0.05)，其余时间点间两两比较差异均无显著性意义(P > 0.05)，见表3。使用Shapiro-Wilk test对两组手术前后的Cobb角数据做正态性检验，发现Cobb角数据均服从正态分布(P > 0.05)。使用Mauchly’s 球形检验分析变量的协方差矩阵是否相等，发现不同时间点的Cobb角不满足球形检验(χ2=34.876，P < 0.001)、不同分组的Cobb角满足球形检验(χ2=0.000，P=1.000)、不同时间点和测量组的交互不满足球形检验(χ2=41.239，P < 0.001)，采用Greenhouse-Geisser统计量对结果进行校正。采用重复测量设计方差分析对两组手术前后的融合节段Cobb角数据做差异性比较，结果显示：组间融合节段Cobb角比较差异无显著性意义(F=0.024，P=0.878)，各时间点间融合节段Cobb角比较差异有显著性意义(F=29.887，P < 0.001)，组别×时间点的交互项的融合节段Cobb角比较差异无显著性意义(F=0.423，P=0.791)；而当交互作用无统计学差异时，可单独分析主效应的意义，不需将每组拆分。采用LSD两两比较法分析不同测量时间点的差异，结果显示，术后各时间点的融合节段Cobb角均高于术前(P < 0.05)，术后12个月的合节段Cobb角低于术后1个月(P < 0.05)，其余时间点间两两比较差异均无显著性意义(P > 0.05)，见表3。 2.6 两组融合材料生物相容性与手术并发症发生情况术后试验组出现喉部疼痛、吞咽困难症状3例，对照组出现喉部疼痛、吞咽困难症状2例，症状在术后4周消失。两组均未出现钢板断裂、融合器退出及下沉等内固定并发症。对照组中有3例出现植骨块沉降，沉降率为8%。 2.7 典型病例影像资料见图4，5。"

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