同种异体骨与纳米人工骨在颈椎双开门椎管扩大术中的应用

Comparison of allogenic versus ostetic artificial bone in double door laminoplasty

目的比较同种异体楔形骨块和纳米人工楔形骨块在颈椎双开门椎管扩大术中的应用效果。方法回顾性研究2004年6月至2010年6月111例患者行颈椎双开门椎管扩大术，其中63例使用同种异体楔形骨块，48例使用纳米人工楔形骨块。所有患者均为多节段的椎管狭窄或颈椎后纵韧带骨化。对所有患者术后行12个月以上随访。分别对两组术前、术后采用测量扁平率了解脊髓功能状态，X线片和CT了解颈椎活动度（ROM）和植骨融合状况。结果末次随访扁平率，异体楔形骨从术前的0．18达到术后的0．43，纳米人工骨从术前的0．20达到术后的0．44。颈椎ROM：异体楔形骨由术前（39．5±6．1）。下降至（22．6±3．3）。；纳米人工骨由术前（39．3±6．7）。下降至（22．9±3．7）°。融合率：异体楔形骨与棘突完全骨性融合：73．1％；部分骨性融合：22．4％；未融合：6．3％。纳米人工骨与棘突完全骨性融合：64．2％；部分骨性融合：18．7％；未融合：17．1％。结论在颈椎双开门椎管扩大术中，植入同种异体楔形骨和纳米人工骨均可获得良好的脊髓减压效果，植入同种异体楔形骨术后融合率相对较高。

Objective To study the application of allogenic bone and Ostetic artificial bone in double door laminoplasty. Methods From June 2004 to June 2010, a total of 111 patients underwent double door laminoplasty. And allogenic （ group A, n = 63 ） and Ostetic artificial （ group B, n = 48 ） bones were used. They had spinal stenosis at least several levels or OPLL （ Ossification of posterior longitudinal ligament）. Their follow-up period was 12 months. Anteroposterior compression ratio was used to evaluate the neurological status. Range-of-movement （ROM） of cervical spine and bone fusion was determined by radiography and computed tomography （CT） during the follow-ups. Results Anteroposterior compression ratio： group A improved from 0. 18 preoperation to 0.43 postoperation while group B increased from 0. 20 preoperation to O. 44 postoperation; ROM ： group A decreased postoperatively to （ 22. 6 ± 3.3 ） o from （39. 5 ± 6. 1 ） ° while group B decreased postoperatively to （ 22. 9 ± 3.7 ） o from （ 39. 3 ± 6. 7 ） °. When Groups A and B were compared, bone fusion between allograft and spinous processes was completed in 73.1% vs 64. 2%, partial fusion in 22.4% vs 18. 7% and failed in 6. 3% vs 17. 1%. Conclusion Uses allogenic and Ostetic artificial bones in double door laminoplasty may achieve an excellent decompression of spinal cord. But the application of allogenic bone yields a higher bone fusion rate after surgery.