纳米羟基磷灰石/聚酰胺66复合生物活性人工椎体在骨质疏松性胸腰椎爆裂骨折前路手术中的应用

Research on application value about bioactive artificial vertebrae of nano-hydroxyapatite and polyamide 66 to anterior approach of osteoporotic thoracolumbar burst fractures

目的 探讨纳米羟基磷灰石/聚酰胺66复合生物活性人工椎体在骨质疏松性胸腰椎爆裂骨折前路手术中应用价值.方法 将2008年1月～2012年9月经前路治疗且获得随访的81例骨质疏松性胸腰椎爆裂骨折患者,根据应用的椎间植骨支撑材料不同分为钛网组41例和人工椎体组40例,测量并比较各组术前、术后、末次随访时伤椎节段后凸角（Cobb角）大小、伤椎邻近上下椎体间高度.结果 81例均获得随访,随访时间12个月以上,术后1周及术后3个月两组的Cobb角及相邻椎间隙高度比较,差异无统计学意义（P＞0.05）;但末次随访时,两组间Cobb角及相邻椎间隙高度改变有统计学意义（P＜0.05）,钛网组的Cobb角及及相邻椎间隙高度改变明显大于人工椎体组;术后复查CT,椎管容积扩大,致压骨块消失,植入骨已与相邻椎体融合,神经功能恢复（Frankel分级）提高1～2级.术中无较大副损伤出现,术后未发生钛合金板与螺丝钉松动、断裂等并发症.结论 骨质疏松性胸腰椎爆裂骨折前路减压彻底,重建方式符合脊柱生物力学分布原则,脊髓功能恢复较好,与钛网比较,纳米羟基磷灰石/聚酰胺66复合生物活性人工椎体具有术后Cobb角改变小,相邻椎间隙高度降低小,在骨质疏松性骨折的脊柱前路手术中使用具有明显优点.

Objective To discuss the value of application of bioactive artificial vertebrae of nano-hydroxyapatite and polyamide 66 to anterior approach of osteoporotic thoracolumbar burst fractures.Methods A retrospective study was done to analyze the 81 patients who had been consecutively treated by anterior internal fixation for osteoporotic thoraeolumbar fractures.According to the difference of bone graft material,they were divided into 2 groups including group of Titanium mesh （41 cases） and group of artificial vertebrae （40 cases）.Radiographic scans were used to measure and compare the Kyphosis angles （Cobb angles） and the height of adjacent vertebral body between preoperation and postoperationas well as between the 2 groups.Results 81 patients were followed-up for 12 months above.There was No significant difference of the Kyphosis angles and the height of adjacent vertebral body between the 1 weeks after operation and 3 months after operation （P〉0.05）,but there was significant difference at the last follow-up （P〈0.05）.The change of kyphosis angles and the height of adjacent vertebral body of the group of Titanium mesh were significantly greater than that of the group of artificial vertebrae.Postoperative CT review demonstrated that spinal canal volume was expanded and The pressure bone has disappeared.The implantation of bone with adjacent vertebral body were fusion,nervous function （Frankel grade） was improved 1-2 grade.No major iatrogenic injuries occurred and no rod break or screw shift was observed postoperatively.Conclusion The anterior spinal operation of osteoporotic thoracolumbar burst fractures allows a complete decompression and reconstrction favors the spinal biomechanics.The nervous function improves satisfactorily.Compared with the titanium mesh,the artificial vertebrae of nano-hydroxyapatite and polyamide 66 have advantages with postoperative the change of Cobb angle little and decrease of adjacent intervertebral height small.It has obvious advantages to be Used in osteoporotic thoracolumbar burst fractures of the spine anterior operation.