两种椎体替代物在重建颈椎稳定性时的疗效比较  

Effectiveness comparison of cervical vertebral restitution after anterior corpectomy by two different kinds of artificial vertebrae

作　　者：梁安靖[1] 张新亮[1] 彭焰[1] 杜开利[1] 黄东生[1] 

机构地区：[1]中山大学孙逸仙纪念医院骨科,广州510120

出　　处：《中国医师进修杂志》2011年第14期16-19,共4页Chinese Journal of Postgraduates of Medicine

基　　金：国家科技支撑计划（2007BAE131304）

摘　　要：目的 比较钛网融合器与新型纳米羟基磷灰石/聚酰胺66（n-HA/PA66）复合生物活性人工椎体在重建颈椎稳定性时的临床疗效.方法 选取25例脊髓型颈椎病患者采用颈前路钛网植骨融合、钛板内固定术治疗（A组）,12例各类颈椎疾病患者采用n-HA/PA66复合生物活性人工椎体植骨融合、钛板内固定术治疗（B组）.比较两种椎体替代物重建颈椎稳定性时的疗效.观察患者椎间隙高度的变化和植骨融合情况,并采用日本矫形外科协会（JOA）评分评价神经功能的变化.结果 随访6～20（15.4±4.2）个月.两组患者末次随访时植骨均已融合.术前JOA评分：A组（8.40±0.96）分,B组（8.33±1.07）分,两组比较差异无统计学意义（P＞0.05）;术后JOA评分：A组（14.36±0.86）分,B组（14.83±0.71）分,两组比较差异无统计学意义（P＞0.05）,但两组各自术前、术后JOA评分比较差异有统计学意义（P＜0.05）.两组优良率均为100%.A组有6例出现钛网下沉,B组有1例出现人工椎体下沉,但均无明显的临床症状.结论 钛网融合器与n-HA/PA66复合生物活性人工椎体均有下沉的可能,且钛网融合器下沉率较n-HA/PA66复合生物活性人工椎体高,但两种椎体替代物均能有效重建颈椎的稳定性,获得良好的融合率,改善脊髓功能.Objective To compare the clinical outcomes of cervical vertebral reconstruction using titanium mesh and nano-hydroxyapatite and polyamide 66 （n-HA/PA66） mesh as two different kinds of artificial vertebrae. Methods From January 2008 to June 2009 had surgically treated 37 cases of cervical spondylosis with anterior corpectomy for decompression, and artificial vertebrae implanted combined platescrews fixation for cervical reconstruction and fusion. As a vertebral substitution, titanium mesh were implanted in 25 cases （ group A ）, and the others （12 cases, group B） were implanted with n-HA/PA66 mesh. The height of fusion space immediately postoperatively and the implanted condition were observed. The fusion rate and the JOA score were recorded to compare the clinical outcomes. Results Two groups received 6-20 （ 15.4 ±4.2 ）months follow-up. When follow-up to the end grafts were already fusion. The preoperative JOA score in group A,B [（8.40 ±0.96） scores vs. （8.33 ±1.07） scores（P ＞ 0.05）] were increased to （14.36 ±0.86）scores and （14.83 ±0.71） scores after postoperatively （P＞ 0.05）,but there were statistically significant differences between preoperative and postoperative each group （P＜0.05）. There were 6 cases artificial vertebrae in group A and 1 case in group B subsided asymptomaticly with 100% choiceness rate. Conclusion These two kinds of artificial vertebrae could show similar outcomes in cervical vertebral reconstruction, but the n-HA/PA66 mesh has a lower subsidence rate.

关 键 词：颈椎病 脊柱融合术 羟基磷灰石类 人工椎体 

分 类 号：R687.3[医药卫生—骨科学]