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目的:探索评价颈椎螺纹融合器内植骨成活情况的无创性方法。方法:选择因颈椎病行颈前路减压钛合金螺纹融合器植骨融合+钢板内固定术的41例患者作为观察组,术后随访3～15个月,以99锝标记的亚甲基二膦酸盐(99mTc-MDP)为显像剂行颈椎核素骨断层扫描,根据计算机“感兴趣区”技术,定量计算出植骨部位与自体胸骨上窝水平胸椎的放射性计数比;另选颈椎病术前患者20例作为对照组,行核素骨断层扫描,计算病变间隙相邻椎体与自体胸骨上窝水平胸椎的放射性计数比作为对照。所有观察组患者同期行颈椎CT重建,分别在矢、冠、轴位观察融合器内植骨融合情况,然后将核素扫描与CT结果对比分析。结果:观察组放射性计数比为1.880±0.293,对照组为1.084±0.016,两组间差异有显著性(P<0.05),观察组植骨成活率为100%。CT重建显示观察组中3例骨性融合较差,骨性融合率为92.7%。结论:应用核素骨断层扫描法可对颈椎融合器内移植骨成活情况做出分析,且骨融合一定说明骨成活,植骨成活却不一定完全骨性融合。
Objective: To explore a noninvasive method to assess the survival of bone graft in cervical spline fusion cage. Methods: Forty-one patients with cervical spondylotic myelopathy underwent anterior cervical decompression with titanium alloy fusion cage and internal fixation were selected as the observation group. The patients were followed up for 3-15 months and treated with 99Tc-labeled methylene Biphosphonate (99mTc-MDP) was used as imaging agent to perform cervical radionuclide bone scintigraphy. According to the computer “area of interest” technique, the radioactive count ratio of the site of bone graft to the level of the thoracic vertebrae on the self-sternum was quantitatively calculated. Twenty patients with cervical spondylosis as control group were treated with radionuclide scintigraphy. The radioactive count of adjacent vertebral bodies in the lesion and the level of the upper thoracic in the suprasternal sternum was calculated as control. All patients in the observation group underwent cervical CT reconstruction in the same period. The fusion of the fusion cage was observed in the sagittal plane, the coronal plane and the axial plane respectively. Then the radionuclide scan and CT results were compared. Results: The radioactive count ratio was 1.880 ± 0.293 in the observation group and 1.084 ± 0.016 in the control group. The difference between the two groups was significant (P <0.05). The survival rate of the bone graft in the observation group was 100%. CT reconstruction showed that 3 cases in the observation group had poor bony fusion and the bony fusion rate was 92.7%. Conclusion: Survival of transplanted bone in cervical fusion cage can be analyzed by radionuclide tomography. And bone fusion must explain the survival of bone, but not completely bone fusion.