可调式人工椎体的改进及其在胸腰椎脊柱结核中的应用  

Modification of an adjustable artificial vertebral body and its application in the treatment of tuber-culosis of the thoracic and lumbar spine

作　　者：王永清[1] 夏仁云[1] 卢世璧[2] 程杰[1] 孙元 郝玉彬 冯雪峰 刘江涛[1] 江霞 孙建文 车海涌 

机构地区：[1]华中科技大学同济医学院附属同济医院骨科,武汉430030 [2]解放军总医院骨科研究所 [3]京航百慕航材高科技股份有限公司生物医学工程事业部 [4]内蒙古呼伦贝尔市第二(结核)医院骨科

出　　处：《中华骨科杂志》2005年第2期92-96,共5页Chinese Journal of Orthopaedics

基　　金：内蒙古科技厅科技合作项目(2004006)

摘　　要：目的从骨组织工程学角度改进可调式人工椎体的结构和生物学性能,用于治疗胸腰椎椎体结核。方法用钛合金制成的框架式结构的可调式人工椎体,表面喷涂羟基磷灰石。在彻底切除病灶,恢复病椎骨膜功能,营造病椎局部良好血运环境的基础上,撑开椎体、纠正脊柱后凸畸形、固定并维持脊柱稳定性、植骨重建骨性结构。治疗破坏较重的胸腰椎椎体结核患者19例,胸椎体结核9例,腰椎体结核10例。其中完全截瘫4例,不完全截瘫7例,有马尾神经综合征8例。均有后凸畸形20°～45°,平均32.7°。合并肺结核15例。术后定期行X线和CT检查观察手术节段稳定性和融合情况。结果随访12～30个月,其中18个月以上11例,平均16个月。2例完全截瘫患者,1例感觉部分恢复,截瘫指数5;1例感觉、运动及二便功能部分恢复,截瘫指数3;余17例完全恢复。后凸畸形纠正20°～35°,平均29.5°。所有患者末次随访骨重建理想、人工椎体稳定,ESR、血象等基本正常,无一例复发。结论在全程、规律、足量、联合的抗结核化疗保护下,彻底切除结核病灶,应用改进的可调式人工椎体治疗由胸腰椎结核引起的严重骨缺损及其并发症是可行的。Objective To modify the structural function and biological capability of adjustable arti-ficial vertebra body (AAVB) and determine the results of its application in the treatment of tuberculosis of the thoracic and lumbar spine. Methods The structure of AAVB was modified by hydroxyapatite-coated porous titanium and the position of fixing screws. There were 19 patients with thoracic and lumbar spine tu-berculosis, 4 with complete paraplegia, 7 with incomplete paraplegia and 8 with cauda equina syndrome. All patients had kyphotic deformity with an average Cobb angle of 32.7° (20°-45°). Tuberculosis of the lung co-existed in 15 patients. After anterior thorough debridement of the tubercular focus, in making of an environ-ment with rich blood supply, then AAVB was implanted to correct kyphotic deformity and fusion was per-formed with autografting. There were 9 AAVB implanted in the thoracic spine and 10 in the lumbar spine. Postoperative X-ray and CT scan were carried out to evaluate the stability and fusion status of the spine. Results The average length of the follow up was 16 months (12-30). 17 patients achieved complete recov-ery of neurological function and 2 patients with complete paraplegia obtained partial recovery postoperative-ly. The mean correction of the kyphotic deformity was 29.5° (20°-35°). The construct and stability of all af-fected spine segments were restored postoperatively, all patients with normal ESR and blood tests. There was no recurrence. Conclusion With adequate and combined chemotherapy and radical debridement of tuber-cular focus, it is feasible to apply the modified AAVB for the treatment of tuberculosis of the thoracic and lumbar spine, satisfactory clinical results can be obtained.

关 键 词：人工椎体 治疗 椎体结核 截瘫 胸腰椎 后凸畸形 骨重建 可调式 恢复 应用 

分 类 号：R687[医药卫生—骨科学]