比较纳米羟基磷灰石/聚酰胺66人工椎体与自体髂骨在颈椎前路减压融合中的应用

Comparison between nano-hydroxyapatite and polyamide 66 composite artificial vertebral body and iliac bone autograft in anterior cervical decompression and fusion

背景:目前用于颈椎前路重建的材料较多,如自体髂骨、同种异体骨、钛网等,但各种材料均存在一定的不足。纳米羟基磷灰石/聚酰胺66人工椎体具有良好的生物相容性及生物安全性,是一种比较理想的椎体植骨替代材料。目的:评估纳米羟基磷灰石/聚酰胺66人工椎体应用于颈椎前路减压融合治疗脊髓型颈椎病的临床效果,并与自体髂骨进行对比。方法:2009-01/2010-03对40例脊髓型颈椎病患者行颈前路椎体次全切减压融合钛板内固定。22例行纳米羟基磷灰石/聚酰胺66人工椎体植骨,18例行自体髂骨块植骨,采用JOA评分法评价神经功能的恢复情况,测量Cobb角评价融合节段曲度以及融合节段椎体前缘、后缘高度。结果与结论:患者均获得6～14个月随访,JOA评分较治疗前明显改善。人工椎体组及自体髂骨组融合节段后缘高度和前凸Cobb角治疗后3个月与治疗后即刻差值、治疗后6个月与治疗后3个月差值差异均有显著性意义(P<0.01)。根据融合标准,治疗后6个月两组融合情况差异无显著性意义(P>0.05)。提示纳米羟基磷灰石/聚酰胺66人工椎体作为颈椎前路植骨材料,融合率同自体髂骨相似,可以有效保持颈椎生理曲度及椎间高度,长期效果有待进一步观察。

BACKGROUND：Plenty of materials,such as autogenous iliac bone,allogeneic bone,and titanium mesh,are used for anterior cervical reconstruction,with each advantages and disadvantages.Nano-hydroxyapatite and polyamide 66（n-HA/PA66） artificial vertebral body has good biocompatibility and biological safety and is an ideal substitute for vertebral body bone graft.OBJECTIVE：To study clinical effect and difference between the n-HA/PA66 composite artificial vertebral body and the iliac bone autograft in anterior cervical decompression and fusion for treatment of cervical spondylotic myelopathy.METHODS：From January 2009 to March 2010,40 cases of cervical spondylotic myelopathy were treated with anterior cervical subtotal corpectomy and fixed by titanium locking plates.22 implanted with n-HA/PA66 composite artificial vertebral body and 18 with iliac bone autograft.The JOA grading system was done in follow up to evaluate neural symptoms,and Cobb＇s angle was measured to evaluate the change of cervical curvature,interverberal height,fusion number at postoperative 6 months was measured.RESULTS AND CONCLUSION：All patients were followed up for 6-14 months.The JOA grading was greatly improved in both groups.But there were significant differences on interverberal posterior height and restoring lordosis of fusion segment at different time intervals（P 0.01）.According to fusion criteria,difference between the two methods was not significant at 6 months and 3 months after treatment（P 0.05）.n-HA/PA66 composite artificial vertebral body was the same fusion rate as iliac bone autograft,and could effectively maintain the biological alignment and cervical intervertebral height.The long-term effects depend on further follow-up.