纳米羟基磷灰石/聚酰胺66椎间融合器与钛网植骨融合治疗多节段脊髓型颈椎病的对比研究  

A comparative study of bone graft fusion with nano-hydroxyapatite/polyamide 66 cage versus titanium mesh cage for treatment of multiple-segment cervical spondylotic myelopathy

作　　者：马远[1] 彭小荷 郭雄飞[1] 程省[1] 宋博 王挺[1] 叶向阳[1] MA Yuan;PENG Xiaohe;GUO Xiongfei;CHENG Sheng;SONG Bo;WANG Ting;YE Xiangyang(Nanyang Central Hospital,Nanyang 473003,Henan,China)

机构地区：[1]南阳市中心医院,河南南阳473003

出　　处：《中医正骨》2020年第10期19-25,共7页The Journal of Traditional Chinese Orthopedics and Traumatology

摘　　要：目的:比较纳米羟基磷灰石/聚酰胺66(nano-hydroxyapatite/polyamide 66,n-HA/PA66)椎间融合器与钛网植骨融合治疗多节段脊髓型颈椎病(cervical spondylotic myelopathy,CSM)的临床疗效及安全性。方法:回顾性分析52例接受颈前路椎体次全切减压植骨融合术治疗的多节段CSM患者的病例资料,其中采用n-HA/PA66椎间融合器者24例(n-HA/PA66组)、采用钛网者28例(钛网组)。男30例,女22例。年龄32~72岁,中位数58岁。2节段CSM38例,3节段CSM14例。比较2组患者的手术时间、术中出血量、术后引流量、住院时间、日本骨科学会(Japanese Orthopaedic Association,JOA)脊髓型颈椎病评分(17分法)、颈部疼痛视觉模拟量表(visual analogue scale,VAS)评分、融合节段高度、融合节段Cobb角、植骨融合率、植骨融合物沉降率及并发症发生情况。结果:2组患者手术时间、术中出血量、术后引流量、住院时间比较,组间差异均无统计学意义[(147.60±30.32)min,(150.48±28.77)min,t=0.351,P=0.727;(130.20±42.67)mL,(127.78±45.43)mL,t=0.197,P=0.845;(57.28±10.20)mL,(60.35±12.56)mL,t=0.957,P=0.343;(15.72±4.32)d,(14.38±5.57)d,t=0.957,P=0.343]。术前和末次随访时,2组患者JOA脊髓型颈椎病评分比较,组间差异均无统计学意义[(12.32±1.23)分,(11.62±2.21)分,t=1.378,P=0.174;(15.25±1.81)分,(15.10±1.74)分,t=0.304,P=0.762];末次随访时,2组患者JOA脊髓型颈椎病评分均高于术前(t=6.559,P=0.000;t=6.547,P=0.000)。术前和末次随访时,2组患者颈部疼痛VAS评分比较,组间差异均无统计学意义[(4.34±1.53)分,(4.55±1.75)分,t=0.457,P=0.650;(1.31±1.03)分,(1.48±0.98)分,t=0.609,P=0.545];末次随访时,2组患者颈部疼痛VAS评分均低于术前(t=8.048,P=0.000;t=8.099,P=0.000)。术前2组患者融合节段高度比较,组间差异无统计学意义[(55.25±10.34)mm,(54.21±7.75)mm,t=0.414,P=0.681];末次随访时,n-HA/PA66组的融合节段高度高于钛网组[(63.19±9.23)mm,(58.32±7.20)mm,t=2.201,P=0.032],2�Objective:To compare the clinical curative effects and safety of bone graft fusion with nano-hydroxyapatite/polyamide 66(n-HA/PA66)cage versus titanium mesh(TM)cage for treatment of multiple-segment cervical spondylotic myelopathy(CSM).Methods:The medical records of 52 patients who received anterior cervical corpectomy and fusion(ACCF)for treatment of multiple-segment CSMwere analyzed retrospectively. Twenty-four patients were treated with n-HA/PA66 cage( n-HA/PA66 group),while the others were treated with TM cage( TM group). The patients consisted of 30 males and 22 females,and ranged in age from 32 to 72 years( Median = 58 yrs). The pathological changes located at two segments( 38 cases) and three segments( 14 cases) respectively. The operative time,intraoperative blood loss,postoperative drainage volume,hospital stay,Japanese Orthopedic Association( JOA) CSM scores,neck pain visual analogue scale( VAS) score,height and Cobb angle of fused segment,bone graft fusion rate,subsidence rate of cage and complications were compared between the 2 groups. Results: There was no statistical difference in operative time,intraoperative blood loss,postoperative drainage volume and hospital stay between the 2 groups( 147. 60 +/-30. 32 vs 150. 48 +/-28. 77 min,t = 0. 351,P = 0. 727;130. 20 +/-42. 67 vs127. 78 +/-45. 43 mL,t = 0. 197,P = 0. 845;57. 28 +/-10. 20 vs 60. 35 +/-12. 56 mL,t = 0. 957,P = 0. 343;15. 72 +/-4. 32 vs14. 38 +/-5. 57 days,t = 0. 957,P = 0. 343). There was no statistical difference in JOA CSM score between the 2 groups before the surgery and at last follow-up( 12. 32 +/-1. 23 vs 11. 62 +/-2. 21 points,t = 1. 378,P = 0. 174;15. 25 +/-1. 81 vs 15. 10 +/-1. 74 points,t =0. 304,P = 0. 762). The JOA CSM scores increased in the 2 groups at last follow-up compared to pre-surgery( t = 6. 559,P = 0. 000;t =6. 547,P = 0. 000). There was no statistical difference in neck pain VAS score between the 2 groups before the surgery and at last follow-up( 4. 34 +/-1. 53 vs 4. 55 +/-1. 75 points,t =0. 457,P =0. 650;1. 31 +/-1.

关 键 词：颈椎病 脊柱融合术 椎间融合器 纳米羟基磷灰石/聚酰胺66 临床试验 

分 类 号：R687.3[医药卫生—骨科学]