羟基磷灰石人工骨在颈椎后路双开门椎管扩大成形治疗中的应用(英文)

Application of hydroxyapatite artificial bone in bilateral open-door posterior cervical expansive laminoplasty

背景:羟基磷灰石人工骨作为骨移植替代物植入人体内不会引起炎症反应、免疫排斥,具有良好的生物相容性,是一种具有骨传导活性的新型植入材料。目的:观察羟基磷灰石人工骨用于颈椎后路双开门椎管扩大成形治疗的效果,比较羟基磷灰石人工骨与自体骨的差异。设计、时间及地点:回顾性病例分析,病例来自于 2001-03/2008-12 中山大学附属第一医院黄埔院区脊柱外科。对象:颈椎病患者 70 例,伴 3 节或 3 节以上压迫或合并颈椎管狭窄;颈椎管狭窄合并颈椎外伤 15 例。方法:行颈椎后路棘突纵切双开门椎管扩大成形治疗,治疗中植入自体骨 23 例,植入羟基磷灰石人工骨 62 例。主要观察指标:①对比观察治疗前后 JOA 评分、手术时间、术中出血量。②材料与宿主的生物相容性。结果:85 例患者术后随访>3 个月。两组间手术前后 JOA 评分比较无显著性意义(P > 0.05) 。羟基磷灰石人工骨组手术用时65～110 min,平均 85.2 min;自体骨组手术用时 75～150 min,平均 116.4 min。羟基磷灰石人工骨组术中出血量 130～400 mL,平均 210 mL;自体骨组手术出血量 170～ 500 mL,平均 260 mL。羟基磷灰石人工骨组除 3 例有羟基磷灰石碎裂外,未发生材料宿主反应及其他严重并发症。结论:羟基磷灰石人工骨用于颈椎后路双开门椎管扩大成形术的效果好,并发症少;手术用时及出血量少。

BACKGROUND： Hydroxyapatite （HA） artificial bone, as bone grafting substitute, would not cause inflammatory reaction or immunological rejection and possesses good biocompatibility after transplantation into human body. It is a novel implant material with bone conduction ability. OBJECTIVE： To investigate the efficacy of HA artificial bone in bilateral open-door posterior cervical expansive larninoplasty and to make a comparison with autogenous bone. DESIGN, TIME AND SETTING： A retrospective case analysis was performed at the Department of Spine Surgery, Hungpuyuan Branch, the First Affiliated Hospital of Sun Yat-sen University from March 2001 to December 2008. PARTICIPANTS： Seventy patients with cervical spondylosis complicated by compression in 3 or more segments or by cervical stenosis and additional fifteen patients with cervical stenosis complicated by cervical trauma were included in this study. METHODS： A bilateral open-door posterior cervical expansive laminoplasty was performed, in which, 23 patients received autogenous bone transplantation （autogenous bone group） and 62 patients underwent HA artificial bone transplantation （HA group）. MAIN OUTCOME MEASURES： （1） Japanese Orthopaedic Association （JOA） score prior to and after surgery, surgery time, and intraoperative bleeding. （2） HA artificial bone-host biocompatibility. RESULTS： All eighty-five patients were followed up for more than 3 months. There was no significant difference in JOA scores no matter prior to or after surgery between the autogenous bone and HA groups （P 〉 0.05）. The surgery time averaged 85.2 minutes （range 65 110 minutes） in the HA group and averaged 116.4 minutes （range 75 150 minutes） in the autogenous bone group. The intraoperative bleeding averaged 210 mL （range 130 400 mL） in the HA group and averaged 260 mL （range 170 500 mL） in the autogenous bone group. There were no material-host response and other severe complications found in each group, except HA artificial bone fragmentation in 3 patients from the HA group. CONCLUSION： HA artificial bone yields good efficacy and causes fewer complications in bilateral open-door posterior cervical expansive laminoplasty; in addition, it requires less time for surgery and causes less bleeding.