颈椎椎间融合器复合涂层及生长因子在山羊体内的融合效果评价  

Effect of hydroxyapatite coat and growth factors for hat type cervical intervertebral fusion cage in the goat cervical spine in vivo

作　　者：顾宇彤[1] 姚振均[1] 李智[2] 王坤[3] 张键[1] 郑学斌[4] 

机构地区：[1]复旦大学附属中山医院骨科,上海200032 [2]复旦大学附属中山医院青浦分院骨科,上海201700 [3]复旦大学附属金山医院骨科,上海200540 [4]中科院上海硅酸盐研究所,上海200032

出　　处：《复旦学报（医学版）》2010年第3期259-264,共6页Fudan University Journal of Medical Sciences

基　　金：复旦大学青年科学基金项目

摘　　要：目的在活体山羊颈椎上比较自体三面皮质髂骨、帽式颈椎椎间融合器(hat type cervical intervertebral fusioncage,HCIFC)、表面喷涂羟基磷灰石的HCIFC及载有生长因子的羟基磷灰石涂层HCIFC的椎间融合效果。方法将32头山羊随机平均分为4组:自体骨组、HCIFC组、羟基磷灰石涂层组及生长因子组。各组均行C3～C4椎间盘切除术并植入以上内植物。于术前、术后即刻及术后1、2、4、8、12周摄颈椎正、侧位X线片,于侧位X线片上测量平均椎间高度(disc space height,DSH)、椎间角(intervertebral angle,IVA)及前凸角(lordosis angle,LA);术后12周处死动物,取C3～C4节段标本进行生物力学测定及组织学评估。结果生长因子组的颈椎屈曲、后伸和侧屈的平均刚度显著大于其他组(P<0.05);羟基磷灰石涂层组后伸、轴向旋转及侧屈的平均刚度显著大于HCIFC组和自体骨组(P<0.05)。影像学及组织学检测结果显示,3个颈椎椎间融合器组的椎间融合效果均好于自体骨组,其中生长因子组的融合效果最好。结论羟基磷灰石涂层可以改善颈椎椎间融合器的融合效果,生长因子能促进骨融合。Objective To evaluate the characteristics of intervertebral fusion using autologous tricortical iliac crest graft,hat type cervical intervertebral fusion cage（HCIFC）,HCIFC coated with hydroxyapatite and HCIFC coated with hydroxyapatite and growth factors in the goat cervical spine models. Methods Thirty-two goats underwent C3-C4 discectomy were randomely divided into 4 groups by the following methods： group 1（n=8）,autologous tricortical iliac crest bone graft（group BG）;group 2（n=8）,HCIFC filled with autologous iliac crest graft（group HCIFC）;group 3（n=8）,HCIFC coated with hydroxyapatite filled with autologous iliac bone（group HA）;group 4（n=8）,HCIFC coating with hydroxyapatite and growth factors filled with autologous iliac graft（group GF）.Radiography was performed pre-and post-operatively and 1,2,4,8,and 12 weeks after operation,respectively.Disc space height（DSH）,intervertebral angle（IVA）,and lordosis angle（LA） were measured in auterior,posterier and lateral view at the same time points.After 12 weeks,the goats were sacrificed and fused segments were harvested.Biomechamical study was performed in flexion,extension,axial rotation,and lateral bending with a nondestructive stiffness method to determine the range of motion and stiffness.All cervical fusion specimens were analyzed in histomorpholoy. Results The stiffness of group GF in flexion,extension and lateral bending was significantly greater than that of the other groups（P〈0.05）.The stiffness of group HA in extension,axial rotation and lateral bending was significantly greater than that of group BG and HCIFC（P〈0.05）.Both radiographic and histomorphologic evaluations showed better fusion in three cage groups than in group. Conclusions Hydroxyapatite coat improves the fusion of the cervical intervertebral cage.Growth factor can promote bone fusion.

关 键 词：颈椎 脊柱融合术 动物实验替代试验 羟基磷灰石涂层 生长因子 山羊 

分 类 号：R318.01[医药卫生—生物医学工程]