纳米羟基磷灰石-聚酰胺66支架钢板内固定治疗颈椎病性肌萎缩  

Nano hydroxyapatite polyamide 66 bioactive cage combined with locking plate fixation for cervical spondylotic amyotrophy

作　　者：王华磊[1] 甄平[2] 汤立新[1] 李果[1] 王海羽 叶向阳[1] WANG Hua-lei;ZHEN Ping;TANG Li-xin;LI Guo;WANG Hai-yu;YE Xiang-yang(Nanyang Central Hospital,Nanyang 473003,China;Orthopedics Center,Lanzhou General Hospital of PLA,Lanzhou 730050,China)

机构地区：[1]河南省南阳市中心医院,473003 [2]兰州军区兰州总医院全军骨科中心,730050

出　　处：《中国矫形外科杂志》2019年第3期199-203,共5页Orthopedic Journal of China

基　　金：国家自然科学基金资助项目(编号:81371983)

摘　　要：[目的]探讨纳米羟基磷灰石-聚酰胺66(n-HA/PA66)生物活性支撑体联合锁定钢板内固定治疗颈椎病性肌萎缩(CSA)的中期疗效。[方法] 2011年1月～2016年12月,本院采用前路减压,n-HA/PA66生物活性支撑体联合锁定钢板内固定治疗颈椎病性肌萎缩患者16例,其中男性10例,女性6例,平均年龄(62.31±12.34)岁。采用疼痛视觉模拟评分(VAS)、JOA评分及SF-36评分评定疗效,X线片评定颈椎曲度、融合节段椎间高度及术后支撑体下沉率,CT三维重建评价融合率。[结果]患者均顺利完成手术,手术时间(94.32±22.25) min;术中出血量(120.80±46.44) ml。术后出现一过性声音嘶哑者1例,吞咽困难2例,经保守治疗3～6个月后恢复。随访时间(52.24±9.82)个月。末次随访VAS评分较术前明显减小,而JOA评分和SF-36评分较术前明显升高,差异有统计学意义(P<0.05)。末次随访时,所有患者肩胛带肌肉肌力和肌肉萎缩情况较术前均有不同程度恢复,功能明显改善。影像学方面,末次随访时颈椎曲度和融合节段椎间高度较术前显著增加,差异有统计学意义(P<0.05);骨性融合率为100.00%,支架下沉率为18.75%。[结论]纳米羟基磷灰石-聚酰胺66生物活性支撑体联合锁定钢板内固定治疗颈椎病性肌萎缩可有效恢复颈椎生理曲度及高度,促进症状改善,显著提升患者神经功能及生活质量。[Objective] To investigate the medium term outcomes of nano-hydroxyapatite polyamide 66(n-HA/PA66) bioactive cage combined with locking plate in anterior decompression for cervical spondylotic amyotrophy(CSA).[Methods] From January 2011 to December 2016,16 patients,including 10 males and 6 females aged(62.31 ±12.34) years on average,underwent anterior decompression and reconstruction with n-HA/PA66 cage combined locking plate for cervical spondylotic amyotrophy.The clinical consequences were assessed by using visual analogue scale(VAS) for pain,Japanese Orthopaedic Association(JOA) cervical score and SF-36 score,while radiographic evaluations were added,such as cervical curvature,intervertebral space height of the involved segment,subsidence of the implant and fusion rate.[Results] All patients had operation performed smoothly in(94.32±22.25) min with intraoperative blood loss of(120.80±46.44) ml on average.Of them,one patient developed postoperative temporary hoarseness and two got dysphagia,which were of complete recovery by conservative therapy till 3 to 6 months postoperatively.The follow-up period lasted for(52.24±9.82) months on average.At the latest follow up,the VAS significantly decreased,whereas the JOA score and SF-36 score significantly increased compared with those before operation(P<0.05).All the patients achieved considerable restoration regarding to the muscle strengths and muscular volume of the shouldergirdle,associated with improved function.In term of radiographic assessment,both cervical curvature and intervertebral space height significantly increased at the latest follow up compared with those preoperatively(P<0.05),accompanied with bony fusion rate of 100% and implant subsidence rate of 18.75%.[Conclusion] The nano hydroxyapatite polyamide 66 bioactive cage combined with locking plate fixation used in anterior decompression for cervical spondylotic amyotrophy does effectively restore the physiological cervical curvature and height,and facilitate improvement of neurological function and

关 键 词：颈椎病性肌萎缩 前路减压术 纳米羟基磷灰石-聚酰胺66生物活性支撑体 颈椎前路钢板 

分 类 号：R681.55[医药卫生—骨科学]