Neulen titanium plate fixation and spinal canal expansion bone grafting for cervical spondylosis: half-year follow-up of healing rate of bone graft

doi:10.3969/j.issn.2095-4344.2014.22.009

Abstract

Abstract:

BACKGROUND: In traditional single open door surgery for cervical spondylosis, door shaft fixation such as suture suspension was used to maintain the open status of vertebral plate, but the fixation effect was not ideal.

OBJECTIVE: To probe into the clinical application of Neulen titanium plate instrument and open-door bone grafting in patients with different types of cervical spondylosis.

METHODS: A total of 32 patients were treated with Neulen titanium plate instrument and open-door bone grafting in unilateral open-door laminoplasty.

RESULTS AND CONCLUSION: A total of 32 patients with cervical spondylosis were followed up for at least

6 months. Neurological function of these patients improved significantly. JOA score improved from (8.7±3.6) to (14.6±2.4), with an improvement rate of (63.3±8.9)% (P < 0.05). In follow-up at 6 months after treatment, X-ray and CT revealed that pivot side crack had disappeared, and spinal canal expansion was satisfactory. No loose, breakage, displacement or re-closing appeared. Results suggested that Neulen titanium plate fixation or open-door side bone grafting could maintain opening state in treatment using cervical posterior single door. Fusion rate of bone graft surrounding titanium plate was 78%. Fork design of both sides of titanium plate made less screws achieve high biomechanical stability. Titanium plate fixation obtained rigid support, but not elastic fixation on the door open side, obtained immediate stability of door shaft side, and easily resulted in bone fusion.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

全文链接：

Key words: cervical spondylosis, internal fixators, bone graft

CLC Number:

R318

Bu Guo-qiang, Zhang Shan-di . Neulen titanium plate fixation and spinal canal expansion bone grafting for cervical spondylosis: half-year follow-up of healing rate of bone graft[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(22): 3493-3497.

Figures/Tables 1

2.1 参与者数量分析纳入患者32例，治疗过程无脱落，随访时间6-15个月，平均(8.3±2.7)个月，全部进入结果分析。 2.2 患者治疗后症状、治疗前后JOA评分及椎管扩大率大部分患者治疗后即出现胸腹部及四肢明显较治疗前轻松感，6个月后复查时四肢活动灵活性改善，行走能力增强，治疗前有尿便功能障碍者治疗后均有改善。JOA评分由治疗前(8.7±3.6)分提高至治疗后(14.6±2.4)分，改善率为(63.3±8.9)%，治疗前后比较差异均有显著性意义(P < 0.05)。治疗后6个月X射线显示C5水平椎管矢状径由治疗前的(8.5±2.1) mm改善至治疗后(13.2±3.4) mm，两者比较差异有显著性意义(P < 0.05)，椎管扩大率为(68.6± 12.3)%。 2.3 患者治疗后影像学观察结果所有患者治疗后X射线及CT均显示椎管扩大满意，Neulen钛板、钛钉位置良好，维持椎板于开门状态，均未见内固定物松动、断裂、移位及再关门的现象。治疗后6个月随访X射线及CT显示门轴侧缝隙消失，提示门轴侧已出现骨性愈合；CT部分层面可见开门侧Neulen钛板周围植骨出现愈合有类似于骨性椎板结构存在(图2)；亦有部分Neulen钛板周围所植骨块出现了吸收，没有达到形成开门侧骨性支撑的目的，但门轴侧同样出现了骨性愈合，仍不影响治疗的效果。作者统计所有Neulen钛板周围植骨的愈合率为78.12%，尚有进一步改良植骨方式的需要。 2.4 患者术中操作时间及出血量所有患者术中操作时间(123.5±35.6) min，出血量为(324.5±70.5) mL。 2.5 并发症患者内固定物置入顺利，未出现神经、血管及脊髓损伤和门轴侧断裂等情况。内固定后住院期间未出现脑脊液漏、感染、切口不愈合等并发症。1例患者内固定后出现暂时性肌力减退，以上肢症状为重，经脱水、应用激素、营养神经等治疗后，经随访3个月时症状缓解。32例患者内固定后均出现颈项部及双侧肩部疼痛，伴有酸胀、僵硬、沉重感但仅9例颈肩部疼痛持续时间超过1个月，该类症状被定义为出现轴性疼痛。轴性疼痛发生率为28.1%。其中2例患者为顽固性轴性疼痛，随访6个月时症状仍未完全缓解。"

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