纳米羟基磷灰石/聚酰胺66椎体支撑体在颈椎前路手术重建中的应用  

Nano-hydroxyapatite/polyamide 66 for vertebral body support in anterior cervical reconstruction

作　　者：宋海涛[1] 张伟[1] 李民[1] 高卫良[1] 吴玉泉[1] 曲绍政 刘彦斌 盛文博 SONG Hai-tao;ZHANG Wei;LI Min;GAO Wei-liang;WU Yu-quan;QU Shao-zheng;LIU Yah-bin;SHENG Wen-bo(Department of Spine Surgery,The 107^th Hospital of PLA,Yantai 264000,China)

机构地区：[1]解放军第107医院脊柱外科,山东烟台264000

出　　处：《中国矫形外科杂志》2018年第17期1560-1564,共5页Orthopedic Journal of China

基　　金：国家科技支撑计划课题-活性纳米复合生物材料制品手术示范与临床应用(编号：2007BAE131304)

摘　　要：[目的]探讨纳米羟基磷灰石/聚酰胺66(n-HA/PA66)椎体支撑体在颈椎前路手术结构重建中的应用及临床效果。[方法]采用n-HA/PA66椎体支撑体行颈椎前路结构重建138例,其中颈椎病81例,后纵韧带骨化症9例,颈椎椎体肿瘤16例,颈椎骨折伴脊髓损伤32例。采用JOA评分改善率和Frankel分级评价患者神经功能恢复情况,根据术后X线片及三维CT判定颈椎序列恢复情况,评估支撑体融合以及下沉移位情况。[结果]138例获得随访,随访时间3~36个月,平均(12.81±1.73)个月。末次随访时,颈椎病、后纵韧带骨化症及颈椎椎体肿瘤患者JOA改善率分别为81.33%、75.92%及69.28%。32例颈椎骨折患者中,27例Frankel分级改善1~3级。所有患者术后3~6个月时支撑体全部融合,平均融合时间(4.54±0.98)个月。影像学检查显示术后颈椎高度、曲度基本恢复正常;最后随访共有5例出现支撑体轻度下沉,下沉率为3.59%;末次随访支撑体融合界面形态良好、无骨吸收。[结论]n-HA/PA66椎体支撑体在颈椎前路手术后中长期能有效维持颈椎高度和正常序列,是颈椎前柱手术重建的理想支撑材料。[Objective] To investigate the clinical outcomes of nano-hydroxyapatite polyamide 66（n-HA/PA66） for vertebral body support in anterior cervical reconstruction.[Methods] The n-HA/PA66 was applied for vertebral body support in anterior cervical reconstruction in 138 patients who underwent anterior cervical spine surgery,including 81 cases of cervical spondylotic myelopathy,9 cases of posterior longitudinal ligament ossification,16 cases of cervical vertebral body tumor and 32 cases of cervical spine fracture with spinal cord injury.The Frankel grading and JOA score improvement rate were conducted for evaluation of neurological function,additionally,the restoration of cervical spine sequence and subsidence displacement of the implant were assessed by X-ray and three-dimensional CT scan.[Results] The 138 patients were followed up for 3~36 months with an average of（12.81±1.73） months.At the latest follow-up,the JOA improvement rate proved 81.33% in the cervical spondylotic myelopathy,75.92% in the posterior longitudinal ligament ossification and 69.28% in the cervical vertebral body tumor.Of 32 patients with cervical fracture,27 patients got 1 to 3-grade improvement in term of Frankel grading.Regarding to imaging examination,the cervical spine height and curvature were basically restored to normal in all patients after the operation.All the patients obtained bony fusion of the support implant from 3 to 6 months with an average of（4.54±0.98） months after operation.At the latest follow up,all the patients revealed the support implant in proper fusion interface shape without bone resorption,despite the fact that 5 patients（3.59%） had slight subsidence of the implant,[Conclusion] N-HA/PA66 vertebral body support can effectively maintain the cervical spine height and normal sequence after anterior cervical operation,which might be an ideal supporting material for anterior cervical surgery reconstruction.

关 键 词：颈椎前路减压术 颈椎前柱重建术 人工椎体 羟基磷灰石 聚酰胺 生物材料 

分 类 号：R318[医药卫生—生物医学工程]