纳米晶胶原基骨材料在腰椎后外侧植骨融合中的临床应用

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

目的探讨使用纳米晶胶原基骨材料(nHAC/PLA)进行腰椎后外侧植骨融合的可行性和效果.方法随访分析了52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术治疗各类腰椎退行性疾病的临床疗效,植骨材料采用nHAC/PLA材料颗粒和自体骨颗粒混合,随访3~15月,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手术疗效;腰椎正、侧位及屈、伸动力侧位X线检查判定融合情况.结果所有病例随访中切口情况良好、未出现排异和感染等迹象;6月和1年术后功能恢复优良率分别为84.8%和89.5%,融合率分别为54.5%和84.2%,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,具有良好的人体生物相容性,在腰椎后外侧植骨融合中可作为自体骨移植的补充,两者混合使用效果接近自体骨,可以弥补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 disease. Methods The clinical outcome of 52 patients with lumbar degenerative disease treated by posterior decompression with posterolateral fusion using nano-crystal/collagen bone materials supplemented with pedicle screw system were retrospective studied. The follow- up period was 3-15 months. The visual analogue scale and spinal operative standard of Chinese medical association were assessed. Lateral views in neutral position, in flexion, and in extension and anteroposterior view of postoperative lumbar roentgenograms were analyzed to identify the quality of fusion. Results All wound healed uneventfully and no abnormity was found in local and systematic examination during follow-up. The good rate of function recovery was 84.8% at six month and 89.5% at twelve month postoperative, while the fusion rate were 54.5% and 84.2% respectively. No pseudoarthrosis occurred. No compliction with pedicle screw system was found. Conclusion The safety of nHAC/PLA used in lumbar posterolateral fusion has been proven. nHAC/PLA have 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, to provide sufficient bone graft volume, while avoiding harvest of iliac.