Contrastive Study Of Cervical Spine Sagittal Aligment After Subtotal Resection With Titanium Mesh Or N-HA/PA66 Bone Graft And Fusion

Objectives:The parameters of cervical spine sagittal positon sequence after anterior cervical vertebral subtotal resection and decompression combining with titanium mesh bone grafting or nano hydroxyapatitie/polyamide 66 artificial bone grafting and fusion were compared to solve the following problems:is there any discrepancy between the influence of different supports on the postoperative cervical sagittal plane balance?2.Does the difference in sagittal plane balance affect the postoperative efficacy?3.Is it possible to evaluate the degree of surgical efficacy by judging sagittal plane balance?Methods:The hospital patients who were selected from Chengdu University of Traditional Chinese Medicine Affiliated Hospital Orthopedics Department ranging from October2013 to March 2017,were all diagnosed with cervical spondylosis and involved in two adjacent segments,having the surgery of anterior cervial copectomy and fusion(ACCF).According to the inclusion criteria and exclusion criteria,there were 30 patients involved.2.Measurement of sagittal parameters: standard lateral cervical X-ray images were taken preoperatively,postoperatively(within 1 week),postoperatively 3,6 and9 months,respectively,and the C0-2Cobb Angle,C2-7Cobb Angle,T1 S,C2-7SVA and TIA were measured and recorded each time.3.Efficacy evaluation indexes:JOA scores of the two groups were recorded preoperatively,postoperatively,3,6 and 9 months after surgery.4.Use SPSS 20.0 for statistical analysis,for example,age by independent sample t-test,gender by chi-square test,the operation section by rank sum test,comparison among groups by One-Way ANOVA,comparison within groups by paired t-test,thecorrelation between data using Pearson Analysis,the clinical curative effect by chi-square test,and P<0.05 meant that differences having statistically significance.Results:The comparison of general data between the two groups showed no statistically differences,among gender,age and surgery segment,which were comparable.The postoperative JOA score of two groups was significantly higher than that before the surgery,and the statistical analysis showed that the difference was significant(P<0.05),and the postoperative functional recovery was better.There was no significant difference in JOA score and JOA improvement rate between the two groups(P>0.05).There were differences in postoperative C0-2Cobb Angle and C2-7Cobb Angle between the two groups,especially C2-7Cobb Angle.The differences were significant at 3,6 and 9 months after surgery(0.003,0.001,0,0).Within the two groups,There was no significant difference in preoperative and postoperative TIA,with significant differences in C0-2Cobb Angle,C2-7Cobb Angle,T1 S,and CSVA Angle.And there were significant differences among C0-2Cobb Angle,C2-7Cobb Angle,T1 S,and CSVA Angle postoperatively and 3,6 and 9 months postoperatively in the titanium mesh group.There was a significant positive correlation between C0-2Cobb Angle and C2-7Cobb Angle(r=0.403,P=0.027),positive correlation between C0-2Cobb Angle and T1S(r=0.463,P=0.010),negative correlation between C0-2Cobb Angle and CSVA(r=-0.471,P=0.009),negative correlation between c2-7cobb Angle and CSVA(r=-0.569,P=0.001),and no significant correlation between TIA and other parameters.Conclusions:1.Anterior cervical surgery had no significant effect on the thoracic inlet Angle.However,by increasing the Angle of C2-7Cobb and C0-2Cobb,increasing T1 S and reducing C2-7SVA,the cervical vertebra 2 moved backward relatively to the cervical vertebra 7,adjusting the head gravity center,and improving the cervical sagittal planebalance.2.Different support bodies had different influences about postoperative cervical sagittal balance,titanium mesh and n-HA/PA66 instantly can improve postoperative cervical sagittal parameters,but in terms of postoperative stability,titanium mesh was poorer,with postoperative sagittal position losing balance early.However,n-HA/PA66 could better sustain cerical sagittal alignment.3.Both Titanium mesh and n-HA /PA66 could well improved and maintained postoperative clinical efficacy within 9 months after surgery,and there was no definite correlation between postoperative changes in sagittal plane balance and postoperative efficacy in the short term,and the long-term effect remains to be further studied.