新型解剖型纳米笼架在腰椎前路椎间融合中的应用

Application of a novel anatomic nano-hydroxyapatite/polyamide 66 cage in XLIF/OLIF surgery

[目的]探讨解剖型纳米羟基磷灰石/聚酰胺66椎间融合器腰椎前路椎间融合术治疗腰椎退行性疾病的初步临床疗效。[方法]2014年2月~2016年2月本院收治23例腰椎退行性疾病患者,采用解剖型纳米羟基磷灰石/聚酰胺66椎间融合器斜向腰椎前路椎间融合术治疗。其中男10例,女13例;年龄51~64岁,平均54.20岁。腰椎间盘突出症13例,退变性腰椎滑脱7例,峡部裂性腰椎滑脱3例;观察手术时间、术中出血量及并发症发生情况,影像学观察椎间隙高度及植骨融合情况,以视觉疼痛模拟评分(VAS)和JOA评分评估临床效果。[结果]23例手术时间40~190 min,平均90 min;术中出血量30~120 ml,平均50 ml;全部病例随访8~26个月,平均18个月。随访期间1例发生术后屈髋和腰大肌无力,予以营养神经等保守治疗3周后症状缓解。余无内固定等相关并发症发生。椎间隙高度由术前平均(5.94±1.25)mm改善至末次随访的(9.58±1.27)mm。术后6个月时椎间植骨融合率91.70%,术前及末次随访腰痛VAS评分分别为(7.21±1.17)分、(0.73±0.69)分,腿痛VAS评分分别为(7.32±1.29)分、(0.79±0.58)分,JOA评分分别为(14.12±2.11)分、(27.42±1.32)分。[结论]解剖型纳米羟基磷灰石/聚酰胺66椎间融合器腰椎前路椎间融合术治疗腰椎退行性疾病初步临床应用疗效满意且并发症发生率低,可以作为腰椎退行性疾病的治疗方式之一。

[Objective] To evaluate the preliminary clinical outcomes of anatomic nano-hydroxyapatite/polyamide 66 cage in extreme lateral interbody fusion （XLIF） / oblique lateral interbody fusion （OLIF） surgery. [Method] From February 2014 to February 2016, 23 patients suffering degenerative lumbar disc diseases underwent XLIF/OLIF surgery with anatomic nano-hydroxyapatite/polyamide 66 cages. The patients included 10 males and 13 females with an average age of 54.2 years, ranging from 51 to 64 years. Of them, 13 patients were diagnosed of lumbar disc herniation, 7 of degenerative spondylolisthesis and 3 of isthmic spondylolisthesis. The operative time, blood loss and complications were recorded, and the fusion rate was determined by radiographic assessment. Additionally, visual analogue score （VAS） and JOA score were used for clinical outcome assessment. [Result] The operation lasted for 90 minutes on average （range, 40-190 minutes） with intraoperative blood loss of 50 ml on average （range, 30-120 ml）. After surgery, all patients were followed up for 8 to 26 months with a mean of 18 mouths. No complication occurred except for 1 case of leg pain after operation, who relieved after 3 weeks of conservative treatment. The intervertebral disc height significantly increased from （5.94± 1.25） mm preoperatively to （9.58 ± 1.27） mm at final follow-up （P〈0.05） . The intervertebral fusion rate was 91.7% at 6 months after operation. The VAS score of low back pain significantly decreased from （7.21±1.17） before operation to （0.73±0.69） at the final follow-up （P〈0.05） , similarly, VAS of leg pain remarkably reduced from （7.32± 1.29） preoperatively to （0.79±0.58） at the latest follow up （P〈 0.05） . In addition, the JOA score significantly increased form （14.12±2.11 ） preoperatively to （27.42±1.32） at the final follow-up （P〈0.05） . [Conclusion] For treatment of degenerative lumbar disc diseases, anatomic nano-hydroxyapatite/polyamide 66 cage is an effective implant to improve interbody fusion in XLIF/OLIF surgery.