纳米晶胶原基骨材料在颈椎前路中的临床应用

Anterior cervical operation using nano-crystal/collagen bone materials

目的 探讨应用纳米晶胶原基骨材料(纳米人工骨)进行颈椎前路减压融合治疗颈椎病的可行性。方法 随访分析了12例采用颈椎前路减压纳米人工骨椎间植入融合结合前路钛合金钢板固定治疗颈椎病的临床疗效,平均随访5.8±0.8月,采用JOA评分评定手术效果;颈椎正、侧位及屈、伸动力侧位X线检查判定融合效果和椎间隙高度恢复维持情况。结果 纳米人工骨块融合率术后3月为81.4％、术后5月为100％;术后1周融合节段椎间隙高度由术前4.9±1.4mm恢复至9.5±1.6mm、颈椎生理前凸部分恢复,末次随访时椎间隙高度和生理前凸保持良好;术后1周JOA评分由术前8.6±1.5分提高至11.6±1.5分、末次随访时为13.8±1.4分;植骨块、钢板、螺钉无松动和移位。结论 颈椎前路减压融合术中应用纳米人工骨临床短期效果接近自体骨移植,避免了取髂骨的各种并发症,缩短了手术时间,纳米人工骨是一种较为理想的颈椎前路手术植骨材料。

Objective To evaluate the efficacy of nano-crystal/collagen bone materials in anterior cervical fusion for patients with cervical spondylosis supplemented with anterior instrumentation. Methods The clinical outcome of 12 patients with cervical spondylosis treated by anterior approach operation using nanocrystal/collagen bone materials supplemented with anterior titanium plate were retrospective studied. The average follow- up period was 5.8±0.8 months. The average preoperative and postoperative JOA scores were assessed. Lateral views in neutral position, in flexion, and in extension of preoperative cervical roentgenograms were analyzed in comparison with one week and five month postoperative films to identify the changes in height of intervertebral space and the quality of fusion. Results The fusion rate of nanocrystal/collagen bone materials in average was 81.4% at three month and 100% at five month postoperative. The height of the fused level were maintained from 4.9±1.4mm preoperatively to 9.54±1.6mm postoperatively. The mean JOA scores were 8.6±1.5,11.64±1.5 and 13.8±1.4 preoperatively, at one week after surgery and at last follow-up examination. Radiographic follow-up revealed that no bone materials, plates, and screws were found displaced or collapsed. Conclusion Nano-crystal/collagen bone materials can replace autologous iliac crest graft in the treatment of patients with cervical spondylosis by anterior operation. This method is safe and effective and can avoid bone graft site morbidity and shorten operative time.