钛网结合表面植骨修复先天性脊椎裂

Titanium alloy net and surface graft for repair of congenital spinal bifida

目的:应用钛网结合表面植骨技术修复先天性脊椎裂骨缺损,随访观察其远期骨修复效果。方法:选择2003-04/2006-04承德北方医院脊柱外科收治的脊椎裂患者36例,其中显性脊椎裂12例,隐性脊椎裂24例,均采用脊柱后正中入路、显露病变两侧的椎板,显性者要先还纳脊膜脊髓结扎囊颈;隐性者分离硬膜与周围软组织的粘连带。选相适宜的钛网(天津市康利民医疗器械有限公司生产)塑形后敷盖骨缺损表面,两侧给予固定,将人工骨或自体骨剪成细小颗粒状植入表面。结果:36例均完成治疗进入结果分析。①随访远期效应:36例术后随访≥12个月。24例隐性突出者术后腰痛症状即消失,2个月后恢复工作,均未再出现腰痛;12例显性脊椎裂患者中,8例脊膜膨出者术后无任何神经系统症状,尿便正常,下肢肌力正常,3例合并有马尾神经部分突出者,术后遗尿症消失,均无下肢功能障碍,切口及周围未再有包块形成,只有1例马尾神经整体膨出着尿便功能障碍及部分下肢功能障碍无明显改善。②植骨区骨愈合情况:植骨区形成紧密的骨性愈合,未出现不愈合、假关节形成和并发症。③宿主反应和材料反应:3例术后出现低热,对症治疗后好转;钛网与宿主骨紧密结合,无排斥和电解反应。结论:钛网表面植骨修复脊椎裂排斥反应小,植入后能与宿主骨形成紧密的骨性结合,能起到近期支撑、远期融合的效果,适用于显性和隐性脊椎裂患者。

AIM： To apply the titanium alloy net combined with bone graft on its surface to restore congenital spinal bifida （SB）, and observe the long-term effect on bone defects through the follow-up. METHODS： From April 2003 to April 2006, 36 SB patients were chosen from Department of Spinal Surgery in Chengde North Hospital, including 12 dominant cases and 24 recessive cases. They all received vertebral column surgery to expose the vertebral plate on both sides＇of lesion via the central posterior vertebral column approach. Dominant cases were treated with spinal meninges and spinal cord returning, then sac-neck ligation was performed; Recessive cases were used to separate the dura mater and surrounding soft tissue adhesion belt. The proper titanium net mould was used to cover bone defect surface, followed by bilateral fixations, and the artificial bone or the autogenous bone was cut into tiny particles, which were implanted on surface. RESULTS： Thirty-six patients were all involved in the result analysis. ①Long-term effect through follow-ups： All the patients were followed up for no less than 12 months. In 24 recessive SB patients, lumbago was found to disappear after operation and nerve reappear, they recovered to work 2 months later; In 12 dominant SB patients, there was no nervous system symptom found in 8 cases of spinal meninogocele, accompanying that feces and urine together with muscular strength of lower limbs were all normal, in other 3 cases complicated with partly protrusion in cauda equina nerve, enuresis-and lower limb disorder did not relapse, no mass formed in the incision and surrounding tissue. Fecal and urinary dysfunction and lower limb disorder were not obviously improved in one case complicated with whole protrusion incauda equina nerve.②Bone healing in graft area： Bone union formed tightly in bone graft area, without bone disunion, nearthrosis formation and complication. ③Host response and material response： Low-grade fever occurred in 3 cases and was improved by symptomatic treatment; The titanium net combined with host bone tightly, having no rejection or electrolysis reaction. CONCLUSION： Bone graft on the surface of titanium alloy net between graft bone and host bone, resulting in support for short applied for both the dominant and recessive SB patients. is effective to restore SB, tight osseous junction forms term and confluence for long term. This method can be