纳米羟基磷灰石/聚酰胺66在胸腰椎结核病灶清除术后椎体重建应用中的长期临床观察  

Anterior reconstruction of spinal defect using nano-hydroxyapatite polyamide 66 cage for thoracolumbar tuberculosis:a long-term follow-up study

作　　者：修鹏[1,2] 宋跃明[1,2] 李涛[1,2] 杨曦[1,2] 周忠杰[1,2] 王亮[1,2] 刘浩[1,2] 刘立岷[1,2] 龚全[1,2] 曾建成[1,2] 孔清泉[1,2] XIU Peng;SONG Yueming;LI Tao(Department of Orthopedics,West China Hospital,Sichun University,Chengdu,610041,China)

机构地区：[1]四川大学华西医院骨科,成都市610041 [2]四川大学华西医院骨科研究所,成都市610041

出　　处：《中国脊柱脊髓杂志》2020年第10期888-895,共8页Chinese Journal of Spine and Spinal Cord

基　　金：国家科技支撑计划课题(编号:2007BAE131304)。

摘　　要：目的:探讨纳米羟基磷灰石/聚酰胺66(nano-hydroxyapatite polyamide 66,n-HA/PA66)椎间支撑体在胸腰椎结核病灶清除术后椎体重建应用中的长期疗效。方法:2009年6月~2010年6月,前瞻性地纳入胸腰椎脊柱结核患者18例,其中男9例,女9例,年龄18~63岁,平均40.6±7.8岁。手术节段胸椎(T3~T10)8例,胸腰段(T11~L2)8例,腰椎(L3~L4)2例;神经功能ASIA分级:C级4例,D级9例,E级5例;合并冷脓肿形成15例,椎管内受累13例,窦道形成2例。患者均采用前路病灶清除、n-HA/PA66椎间支撑体结合自体骨椎间植骨、前路内固定术治疗,术后规律抗结核治疗18个月,术后3个月、6个月、1年及之后每年通过门诊或电话随访记录患者的胸背痛VAS评分、神经功能(按照ASIA分级)变化;并根据X线片及CT观察植骨融合、支撑体下沉、后凸畸形纠正和维持的情况。结果:所有患者均成功完成手术,除2例术后出现胸腔积液外,无严重并发症出现;本组病例随访5~10年,平均7.5±1.8年。除1例术前为ASIA分级C级的患者恢复为D级外,其余病例均恢复为E级;胸背痛VAS评分由术前7.0±1.8分缓解为术后2.4±0.6分,至末次随访时为1.4±0.4分;术前后凸为11°~82°(31.0°±11.6°),术后即刻为2°~46°(18.2°±9.6°),后凸矫正10°~36°(13.0°±8.3°),末次随访时后凸为3°~56°(22.5°±8.1°),后凸丢失1°~11°(4.3°±0.8°);术后6个月10例(56%)获得骨性融合,术后1年17例(94%)获得融合,术后2年所有病例均获得融合,骨融合发生较慢主要见于2个以上运动节段病椎切除重建的病例;支撑体下沉发生11例(61%),主要发生于术后6个月以内,下沉0~6mm(3.0±0.7mm),1例椎旁脓肿复发和窦道形成,经过换用二线抗结核药物、加强营养、换药等处理治愈。结论:经过5年以上的长期随访证实,n-HA/PA66椎体支撑体可安全有效地应用于胸腰椎结核病灶清除术后前柱重建。Objectives:To evaluate the safety,reliability of n-HA/PA66 cage in the management of thoracolumbar tuberculosis after a long-term follow-up study.Methods:18 patients with spinal tuberculosis,including 9 males and 9 females,were treated using debridement and strut graft with n-HA/PA66 cage combined with anterior instrumentations.The average age was 40.6±7.8 years(range,18 to 63).The surgical levels included thoracic spine(T3-T10)in 8 cases,thoracolumbar spine(T11-L1)in 8 cases,and lumbar spine(L2-L4)in 2 cases.Kyphosis deformity presented in 13 patients with a Cobb angle of 31.0°±11.6°(range,11°to 82°).According to ASIA grading system,neurological status was grade C in 4 patients,grade D in 9 and grade E in 5.Cold abscess formation,spinal canal involvement and sinus tract formation were found in 15,13 and 2 patients respectively.Routine anterior debridement,inter-body strut graft and fixation with screwrod system were applied.Anti-tuberculosis chemotherapy was continued for at least 18 months postoperatively.Results:All patients were successfully managed with this procedure.Except for 2 patients with pleural effusion post operation,no serious complications occurred.They were followed up for 7.5±1.8 years(range,5 to 10 years).Except for one patient who had the preoperative ASIA grade improved from C to D,all other patients with neurologic deficit improved to normal at the last visit.The VAS score of back pain was relieved from 7.0±1.8(range,5 to 9)points to 2.4±0.6(range,0 to 3)points after surgery,an it was 1.4±0.4(range,0 to 3)points at the final visit.The kyphosis was 31.0°±11.6°(range,11°to 82°)before operation,and it was 18.2°±9.6°(range,2°to 46°)immediately after operation with correction of 13.0°±8.3°(range,10°to 36°).The kyphosis deteriorated to 22°±8.1°(range,3°to 56°)at final follow-up with correction loss of 4.3°±0.8°(range,1°to 11°).Bone fusion was achieved in 10 cases(56%)at 6 months after operation and in 17 cases(94%)at 1 year after operation.All cases achieved bony

关 键 词：脊柱结核 前路手术 纳米羟基磷灰石/聚酰胺66 

分 类 号：R529.2[医药卫生—内科学] R687.3[医药卫生—临床医学]