纳米羟基磷灰石／聚酰胺66椎体支撑体在下颈椎骨折脱位前路手术重建中的应用  

Application of n-HA/PA66 composite artificial vertebral body in anterior reconstruction of lower cervical spine fracture and dislocation

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

机构地区：[1]四川大学华西医院骨科,成都610041

出　　处：《中华外科杂志》2012年第4期338-341,共4页Chinese Journal of Surgery

基　　金：国家科技支撑计划课题（2007BAEl31304）

摘　　要：目的探讨纳米羟基磷灰石／聚酰胺66（n-HA／PA66）椎体支撑体在下颈椎骨折脱位前路手术重建中应用的临床治疗效果。方法2008年1月至2010年7月，84例下颈椎骨折脱位患者行前路椎体次全切除、椎管减压，以n-HA／PA66椎体支撑体支撑植骨、钢板螺钉内固定治疗，其中男性60例，女性24例；年龄18-75岁，平均45．7岁。随访以Frankel分级标准评价患者神经功能恢复情况，复查X线片及三维CT评估支撑植骨融合情况，包括椎问高度、生理曲度及支撑体是否下沉。结果84例患者均成功完成颈椎前路减压手术以及支撑体的安放固定，并获得随访，随访时间6-24个月，平均12个月。所有患者的术前症状均得到不同程度的改善，根据Frankel分级标准评定，平均改善1．0级。影像学检查显示所有患者植骨融合，颈椎序列、椎问高度、颈椎稳定性以及支撑体的位置维持良好，支撑体无下沉、移位。术后即刻椎间高度（2．4±0．2）cm，术前椎间高度（1．9±0．1）cm，两组比较差异有统计学意义（q=2．48，P〈0．001）。术后即刻、3个月、1年、2年不同时期随访各组椎间高度比较，差异无统计学意义（P〉0．05）。术前颈椎融合节段Cobb角为9．8°±1．2°，术后即刻Cobb角为16．6°±1．2°，术后颈椎Cobb角与术前相比差异有统计学意义（q=14．25，P〈0．001）。术后即刻、3个月、1年、2年不同时期随访各组间比较，差异无统计学意义（P〉0．05）。结论n-HA／PA66椎体支撑体具有早期支撑稳定功能，可有效维持颈椎生理曲度和椎间高度；术后植骨融合率高且便于X线片观察，是进行颈椎骨折脱位前路手术植骨的理想支撑材料，但长期效果需进一步随访观察。Objective To initially evaluate the application of artificial vertebra of n-HA/PA66 in anterior reconstruction of lower cervical spine fracture and dislocation. Methods In this study, 84 patients with lower cervical spine fracture and dislocation received anterior cervical discectomy, spinal canal decompression or subtotal corpectomy, spinal canal decompression and reconstruction by n-HA/PA66 composite artificial vertebral body combined with plate instrumentation. Neurological function was followed up by improvement rate of Frankel and situations of the supporting body was observed by X ray and 3D-CT in 3, 12, 24 months postoperatively. The intervertebral height, physical arc （reflected by Cobb angle） and the locations and fusion rate of the supporting body were assessed in order to evaluate the stability of the cervical spine and alignment improvements. Results All the patients underwent operation successfully and were followed up for 6 to 24 months with an average of 12 months. The preoperative symptoms were improved to varying degrees. Imaging studies showed that in all cases graft fusion were achieved, and cervical alignments, intervertebral height, cervical spine stability and the locations of the artificial vertebral body were well maintained . No displacement and subsidence of the artificial vertebral body occurred.Postoperative immediate intervertebral height （ 2. 4±0. 2 ） era, preoperative intervertebral height （ 1.9±0. 1 ）cm, comparisons of the two grnups was statistically significant （q = 2. 48, P 〈 0. 001 ）. The immediate, 3 month, 1 year, 2 year period follow-up group intervertebral height was not statistically significant （P 〉 0. 05 ）. Preoperative Cobb angle was 9. 8°±1. 2° postoperative immediate Cobb angle was 16. 6°±l. 2°, comparisons of the two grnups was statistically significant （ q = 14. 25, P 〈 0. 001 ）. The immediate, 3 month, 1 year, 2 year period fullow-up group Cobl） angle was not statistically significant （ P 〉 0. 05 ）. Conclusions n-HA/PA6

关 键 词：颈椎 脊柱骨折 脱位 假体和植入物 羟基磷灰石类 纳米结构 

分 类 号：R687.3[医药卫生—骨科学]