纳米羟基磷灰石/聚酰胺66支撑体重建肿瘤切除术后脊柱稳定性的初步应用  

APPLICATION OF NANO-HYDROXYAPATITE/POLYAMIDE 66 CAGE IN RECONSTRUCTION OF SPINAL STABILITY AFTER RESECTION OF SPINAL TUMOR

作　　者：汪雷[1] 宋跃明[1] 裴福兴[1] 屠重棋[1] 段宏[1] 刘浩[1] 刘立岷[1] 龚全[1] 李涛[1] 曾建成[1] 孔清泉[1] 

机构地区：[1]四川大学华西医院骨科,成都610041

出　　处：《中国修复重建外科杂志》2011年第8期941-945,共5页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：国家科技支撑项目课题(2007BAE131304)~~

摘　　要：目的探讨纳米羟基磷灰石/聚酰胺66(nano-hydroxyapatite/polyamide 66,n-HA/PA66)支撑体在脊柱肿瘤切除后脊柱稳定性重建中的安全性及临床疗效。方法 2008年1月-2009年12月,对11例脊柱肿瘤行前路或前后联合入路肿瘤切除、n-HA/PA66支撑体椎间植入重建脊柱稳定性。男6例,女5例;年龄16～61岁,平均44.5岁。病程2～14个月,平均6.8个月。其中转移癌5例,骨巨细胞瘤2例,骨母细胞型骨肉瘤1例,软骨肉瘤1例,非霍奇金淋巴瘤2例。病变位于颈椎2例,胸椎6例,腰椎3例。术前Frankel神经功能分级为A级1例,B级3例,C级2例,D级2例,E级3例。结果手术切口均Ⅰ期愈合,未见严重术中及术后并发症。3例肝癌转移及1例肺癌转移患者于术后5～9个月因原发疾病死亡;余7例术后随访时间10～18个月,平均14.4个月。术后3个月Frankel神经功能分级较术前不同程度改善。X线片及三维CT示n-HA/PA66支撑体无明显塌陷、下沉、断裂及移位,内固定物位置良好。术后6个月存活的10例患者植骨均达骨性融合。术前病椎邻近上、下椎间高度为(97.5±15.4)mm,术后3个月和末次随访时分别为(110.5±16.1)mm和(109.4±16.2)mm,与术前比较差异均有统计学意义(P<0.05);术后3个月与末次随访比较,差异无统计学意义(P>0.05)。2例前路经胸手术患者术后出现双侧胸腔积液,予以穿刺抽液及胸腔闭式引流术后痊愈。随访期间1例L3椎体骨巨细胞瘤术后7个月原位复发,1例T11椎体软骨肉瘤患者术后14个月在L3椎体复发,均再次行肿瘤切除、n-HA/PA66支撑体植入重建术,术后随访无复发,原手术部位达骨性融合。结论 n-HA/PA66支撑体具有良好的安全性和椎间支撑稳定作用,植骨融合满意,是一种较理想的新型脊柱前路重建方法。Objective To evaluate the security and effectiveness of nano-hydroxyapatite/polyamide 66 （n-HA/PA66） cage in reconstruction of spinal stability after resection of spinal tumor. Methods Between January 2008 and December 2009, 11 patients with spinal tumor underwent surgical resection and strut graft with n-HA/PA66 cage. There were 6 males and 5 females with an average age of 44.5 years （range, 16-61 years）. The average disease duration was 6.8 months （range, 2-14 months）. The locations of lesions included cervical spine （2 cases）, thoracic spine （6 cases）, and lumbar spine （3 cases）. Among them, there were 5 metastatic carcinomas, 2 giant cell tumors, 1 osteoblastsarcoma, 1 chondrosarcoma, and 2 non-Hodgkin lymphoma. According to Frankel criteria for nerve function classification, there were 1 case of grade A, 3 cases of grade B, 2 cases of grade C, 2 cases of grade D, and 3 cases of grade E. Results Incisions healed by first intention in all patients, no operative or postoperative complication occurred. Four cases of metastatic carcinoma died of primary disease during 5-9 months after operation. Seven cases were followed up 14.4 months on average （range, 10-18 months）. All patients gained significant improvement of the neurological function at 3 months after operation. All cases obtained bone fusion and good spinal stability without displacement and subsidence of the n-HA/PA66 cage. The intervertebral height of the adjacent segments was （110.5±16.1） mm at 3 months after operation and （109.4±16.2 ） mm at the final follow-up, showing significant differenecs when compared with the preoperative height [（97.5±15.4） mm, P 〈 0.05], but no significant difference between 3 months after operation and the final follow-up. In 2 patients undergoing surgery via anterior approach, bilateral pleural effusion on both sides occurred and were cured after dosed thoracic drainage. During the follow-up, 2 cases （1 chondrosarcoma and 1 giant cell tumor） relapsed and underwent reoperation

关 键 词：脊柱肿瘤 纳米羟基磷灰石/聚酰胺66支撑体 脊柱稳定性重建 

分 类 号：R738[医药卫生—肿瘤]