应用纳米晶胶原基骨材料行腰椎后外侧融合初步效果分析

Posterolateral fusion using nano-crystal/collagen bone materials in lumbar spine

目的: 探讨在腰椎后外侧植骨融合中应用纳米晶胶原基骨材料(nHAC/PLA) 的可行性和效果。方法: 随访分析64例腰椎多节段椎板切除减压、后外侧植骨融合辅助椎弓根螺钉内固定治疗各类腰椎退行性疾病的临床疗效, 植骨材料采用nHAC/PLA颗粒和自体骨颗粒混合, 采用VAS疼痛10分法和中华医学会骨科分会脊柱外科组手术疗效标准评估; 腰椎正、侧及屈、伸动力位X线片判定融合情况。结果: 所有病例切口愈合良好; 1年和1年半复诊术后功能恢复优良率分别为90. 3%和94. 4%, 融合率分别为83. 9%和88. 9%, 假关节发生率为0, 椎弓根螺钉无松动和移位。结论: 纳米晶胶原基骨材料在腰椎后外侧植骨融合中应用是安全的, 具有良好的生物相容性, 可作为自体骨移植的补充, 两者混合使用效果接近自体骨, 弥补了减压过程中自体骨的不足, 避免再取髂骨。

Objective:To evaluate the efficacy of nano-crystal/collagen bone materials in posterolateral lumbar fusion for patients with lumbar degenerative diseases.Method:The clinical outcome of 64 patients with lumbar degenerative diseases treated by posterior decompression with posterolateral fusion using nano-crystal/collagen bone materials supplemented with pedicle screw system were retrospectively studied.The visual analogue scale and spinal operative standard of Chinese medical association were assessed. Lateral views in neutral position,flexion,and extension and anteroposterior view of postoperative lumbar roentgenograms were analyzed to identify the quality of fusion.Result:All wound healed uneventfully and no abnormity was found in local and systematic examination during follow-up. The good rate of functional recovery was 90.3% in the 12th month and 94.4% in the 18th month postoperatively,while tile fusion rate were 83.9% and 88.9% respectively. No pseudoarthrosis occurred.No complication with pedicle screw system was found.Conclusion:The safety of nHAC/PLA used in lumbar posterolateral fusion has been proven,nHAC/PLA has excellent biocompatibility.This study shows the effective results of nHAC/PLA combined with autologous bone in posterolateral lumbar fusion were similar to that of autologous bone.nHAC/PLA can be used as supplement to autologous bone,while avoiding harvest of iliac.