聚DL-乳酸融合器促进山羊C3，4节段椎间融合作用的研究  

Reconstruction of segmental stability of goat cervical spine with poly （D, L） Lactide cage

作　　者：李晓辉[1] 宋跃明[2] 段宏[2] 

机构地区：[1]天津市天津医院,300211 [2]四川大学华西医院骨科,成都

出　　处：《中华骨科杂志》2015年第8期871-878,共8页Chinese Journal of Orthopaedics

摘　　要：目的探讨聚DL-乳酸（poly（D，L）Lactide，PDLLA）融合器（cage）促进山羊C3。4节段椎间融合的生物力学稳定性和成骨作用。方法24只雌性山羊随机分为三组：PDLLAcage组（8只）、钛合金cage组（8只）和三面皮质髂骨组（8只）。切除C3-4。椎间盘，分别植入PDLLAcage、钛合金cage和三面皮质髂骨。于术前、术后及术后1、2、4、8、12周摄X线片，测量平均椎问高度、椎问角及前凸角，术后12周摄X线片后处死动物，进行平均刚度及活动范围等生物力学评估，并进行组织学观察。结果术后各时点PDLLAcage组、钛合金cage组和三面皮质骨组的前凸角差异无统计学意义；术后4周，PDLLAcage组椎间角大于三面皮质骨组，差异有统计学意义；术后8、12周，PDLLAcage组平均椎间高度大于三面皮质骨组，差异有统计学意义。在侧屈和旋转加载下，各组C3．4节段的刚度差异有统计学意义，其中两个cage组均较三面皮质髂骨组大，而钛合金cage与PDLLAcage组的差异无统计学意义；三组间活动范围的差异有统计学意义，其中两个cage组均优于自体髂骨组。组织学观察见PDLLAcage组融合部位大量新生骨和软骨形成。结论PDLLAcage生物相容性好、可为骨长入和界面成骨提供适合的生物学环境；其在维持椎间高度，增加融合节段的稳定性等方面具备潜在优势，能为最后的骨性融合提供良好的生物力学环境。Objective To design a type of poly （D, L） Lactide （PDLLA） cage, compare the characteristics of inter body fusion using PDLLA cage with those of titanium cage and autologous tricortical iliac crest graft in a goat cervical spine model in vivo. Methods Twenty-four goats underwent C3-4 discectomy and fusion were assigned to 3 groups, PDLLA cage group （n=8）, titanium alloy cage group （n=8） and autologous iliac bone group （n=8）. Radiography was performed preand post-operatively and 1, 2, 4, 8, and 12 weeks after operation. At the same time points, disc space height （DSH）, intervertebral angle （IVA）, and lordosis angle （LA） were measured. After 12 weeks, the goats were killed and fusion sites were harvested. Biomechanical testing was performed in flexion, extension, axial rotation, and lateral bending to determine the stiffness and range of motion. All cervical fusion specimens underwent histomorphological observation. Results The 1VA of PDLLA cage 4 weeks after operation and DSH 8 and 12 weeks after operation was statistically greater than that of autologous iliae bone graft （P〈0.05）. The LA values were shown no significant difference among PDLLA cage, Titanium cage and autologous iliac bone graft groups. The stiffness of two types of cages in axial rotation and lateral bending, the ROM in every movement was statistically greater than that of autologous iliac bone graft group （P〈0.05）. PDLLA cage and Titanium cage had no significant difference （P〉0.05）. Radiographic and histomorphological observation showed better fusion results in cage groups than in autologous bone group. Conclusion This type of PDLLA cage has excellent biocompatibility and can provide an appropriate biological environment for bone ingrowth and osteogenesis at bone-implant interface. Furthermore, PDLLA cage can maintain DSH and increase the stability of fusion segments to create a good biomechanical environment for the last bone fusion.

关 键 词：颈椎 脊柱融合术 动物实验 生物力学 

分 类 号：R687.3[医药卫生—骨科学]