纳米羟基磷灰石/聚酰胺66椎体支撑体在脊柱前柱手术重建中的应用

Application of n-HA/PA66 composite artificial vertebral body in anterior spinal reconstructive surgery

[目的]探讨纳米羟基磷灰石/聚酰胺66(nano-hydroxyapatite polyamide66,n-HA/PA66)椎体支撑体在脊柱前柱手术重建中应用的临床治疗效果。[方法]2008年1月～2010年10月采用n-HA/PA66椎体支撑体行脊柱前柱重建手术434例,男332例,女102例,年龄18～72岁,平均43.2岁;颈椎骨折84例,胸腰椎骨折202例,脊髓型颈椎病148例。随访以脊髓神经功能Frankel分级和日本矫形外科学会(japan orthopaedic association,JOA)评分改善率评价患者神经功能恢复情况;复查X线片及三维CT了解术后脊柱序列恢复情况,评估支撑体融合以及下沉移位情况。[结果]395例患者获得随访,随访时间3～24个月,平均11.4个月。末次随访时,颈椎骨折和胸腰椎骨折患者中,分别有16例和17例完全性脊髓损伤患者术后脊髓功能无恢复,其余Frankel分级分别平均提高1.1级和1.3级;颈椎病患者术后3个月及末次随访JOA改善率76.7%、80.8%。影像学检查显示术后脊柱高度、曲度基本恢复正常;颈椎骨折与颈椎病患者术后3个月时支撑体全部融合(融合率100%),后未见下沉;胸腰椎骨折患者支撑体平均融合时间4.1个月,融合率96.2%,有9例出现少量下沉(下沉率4.9%)。[结论]n-HA/PA66椎体支撑体可有效维持脊柱高度和正常序列,术后植骨融合率高,长期随访效果满意,是进行脊柱前柱手术重建的理想支撑材料。

[ Objective] To initially evaluate the clinical result of n-HA/PA66 composite artificial vertebral body in anterior spinal reconstructive surgery. [ Method] In this study ,434 patients received anterior spinal reconstructive surgery by n-HA/PA66 composite artificial vertebral body combined with spinal internal fixation instrumentation between January 2008 and October 2010. There were 84 cases of cervical spine fracture ,202 cases of thoracic or lumbar spine fracture and 148 cases of cervical spondylotie myelopathy. Neurological function was followed up by the Frankel grading and improvement rate of JOA score. The alignment improvement of the spine and the fusion rate and locations of supporting body were assessed by X ray and CT. [ Result] All patients underwent operation successfully and 395 patients were followed up for 3 to 24 months with an average of 11.4 months. The patients with cervical spine fracture gained 1.1 grades, on average, and recovery of neurological function had no change in 16 cases （ grade A）. The patients thoracic or lumbar spine fracture gained 1.3 grades on average, and recovery of neurological function had no change in 17 cases （grade A） in the last follow-up. JOA improvement rates in cervical spondylotic myelopathy were 76.7% and 80.8% at 3 month after operation and at the last follow-up. Imaging studies showed that the intervertebral height and spinal alignment were well maintained. In all cases of cervical spine fracture and cervical spondylotic myelopathy, graft fusion were achieved （ fusion rate 100% ） at 3 months after operation and the supporting body was not subsidenced. But in the cases of thoracic or lumbar spine fracture, the fusion rate was 96.2% , and the fusion time was average 4.1 months. There were 9 cases of the supporting body subsidency （subsidency rate 4. 9%）. [ Conclusion] n-HA/PA66 composite artificial vertebral body can effectively maintain the spinal biological alignment and intervertebral height. It has higher rate of graft fusion and higher satisfaction in the long-term follow-up study. Therefore, n-HA/PA66 composite artificial vertebral body can be taken as an ideal graft for anterior spinal reconstructive surgery.