南方医科大学学报

南方医科大学学报 ›› 2019, Vol. 39 ›› Issue (04): 409-.doi: 10.12122/j.issn.1673-4254.2019.04.05

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新型解剖型钛笼可提高终板的支撑强度：基于影像学及生物力学方法

卢腾，高中洋，贺西京，李家良，刘宁，梁辉，王一斌，闻志靖，张廷，王栋，李浩鹏   

  • 出版日期:2019-04-20 发布日期:2019-04-20

Effects of a new anatomical adaptive titanium mesh cage on supportive load at the cervical endplate: a morphological and biomechanical study

  • Online:2019-04-20 Published:2019-04-20

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摘要： 目的评价新型解剖型钛笼（AA-TMC）在单节段及双节段颈前路椎体次全切植骨融合术（ACCF）中与终板的贴合程度以 及对手术节段颈椎生理序列的重建效果。方法使用12具颈椎尸体标本完成单节段及双节段ACCF手术，使用AA-TMC进行椎 体重建。通过X线测量手术前后手术节段高度及角度以评价AA-TMC对手术节段生理序列的重建效果。同时测量术后AA-TMC 与终板之间间隙大小以评价AA-TMC与终板的贴合程度。根据美国材料与实验学会F2267 脊柱植入物沉陷试验标准对比 AA-TMC与传统钛笼在终板支撑强度上的差异，评价AA-TMC在防止钛笼下沉方面的效果。结果单节段ACCF手术前后节 段高度（23.90±2.18 mm vs 24.23±1.13 mm）及角度（11.62±2.67° vs 12.13±0.69°）之间无统计学差异（P>0.05）。双节段ACCF手术 前后节段高度（42.93±3.51 mm vs 43.04±1.70 mm）及角度（15.63±5.06° vs 16.16±1.05°）之间无统计学差异（P>0.05）。AA-TMC 与终上下板贴合良好，平均间隙0.37±0.3 mm及0.42±0.28 mm。相比于传统钛笼，单节段及双节段ACCF使用AA-TMC进行椎 体重建可显著提高终板支撑强度（单节段ACCF：719.7±5.5 N vs 875.8±5.2 N；双节段ACCF：634.3±5.9 N vs 873±6.1 N），差异具 有统计学意义（P<0.05）。结论在单节段及双节段ACCF中使用AA-TMC进行椎体重建可显著提高终板支撑强度，从而有效降 低了钛笼下沉发生的可能。并且，使用AA-TMC可有效重建颈椎生理序列。

Abstract: Objective To assess the geometrical matching of a new anatomical adaptive titanium mesh cage (AA-TMC) with the endplate and its effect on cervical segmental alignment reconstruction in single- and two-level anterior cervical corpectomy and fusion (ACCF) and compare the compressive load at the endplate between the AA-TMC and the conventional titanium mesh cage (TMC). Methods Twelve cervical cadaveric specimens were used to perform single- and two-level ACCF. The interbody angle (IBA), interbody height (IBH) and the interval between the AA-TMC and the endplate were evaluated by comparison of the pre- and postoperative X-ray images. The maximum load at the endplate was compared between the AA-TMC and TMC based on American Society for Testing and Materials (ASTM) F2267 standard. Results No significant differences were found between the preoperative and postoperative IBA and IBH in either single-level ACCF (11.62°±2.67° vs 12.13°±0.69° and 23.90±2.18 mm vs 24.23±1.13 mm, respectively; P>0.05) or two-level ACCF (15.63°±5.06° vs 16.16°±1.05°and 42.93±3.51 mm vs 43.04 ±1.70 mm, respectively; P>0.05). The mean interval between the AA-TMC and the endplate was 0.37 ± 0.3 mm. Compared to the conventional TMC, the use of AA-TMC significantly increased the maximum load at the endplate in both single-level ACCF (719.7±5.5 N vs 875.8±5.2 N, P<0.05) and two-level ACCF (634.3±5.9 N vs 873±6.1 N, P<0.05). Conclusion The use of AA-TMC in single-level and two-level ACCF can significantly increase the maximum load at the endplate to lower the possibility of implant subsidence and allows effective reconstruction of the cervical alignment.