前路减压n-HA/PA66支撑植骨内固定治疗胸腰椎爆裂骨折的近期临床效果

Preliminary outcome of anterior decompression，n-HA/PA66 implantation and fusion for thoracolumbar burst fracture

中文关键词:  纳米羟基磷灰石/聚酰胺66  椎体支撑体  胸腰椎  爆裂骨折  前路手术

英文关键词:Ｎano-hydroxyapatite/polyamide 66  Ｖertebral supporter  Ｔhoracolumbar  Ｂrust fracture  Ａnterior surgery

中文摘要:

  【摘要】 目的：评价前路减压纳米羟基磷灰石/聚酰胺66（n-HA/PA66）支撑植骨内固定治疗胸腰椎骨折的近期临床疗效。方法：2007年9月~2010年10月，我院采用经前路减压n-HA/PA66植骨融合内固定术治疗胸腰椎爆裂骨折患者214例，其中男153例，女61例，年龄19~58岁，平均37.6岁。随访观察术前、术后1周及末次随访时患者神经功能情况以及影像学资料。神经功能情况使用Frankel分级标准进行评价；侧位X线片上测量伤椎节段后凸Cobb角、椎间高度；CT三维重建（3D CT）观察植骨融合情况。结果：188例患者获得术后随访，随访时间6~36个月，平均17.8个月，患者神经功能术前：A级20例，B级38例，C级59例，D级47例，E级24例；至末次随访时：A 级17例，B级9例，C级20例，D级46例，E级96例。术前平均后凸Cobb角为17.5°，术后1周时5.4°，末次随访时5.7°；术前、术后1周以及末次随访平均伤椎上下椎间高度分别为97.9mm、109.0mm、108.4mm，术后椎间高度丢失平均为0.6mm，支撑体下沉（椎间高度丢失≥2mm）为9例（4.8%）；至末次随访时椎体支撑体植骨融合率为96.3%；未发现广泛感染、椎体支撑体移位、断裂等并发症。结论：前路减压、n-HA/PA66支撑植骨内固定治疗胸腰椎爆裂骨折安全有效。术后支撑体植骨融合率高，下沉率低，并发症少，是一种较为理想的胸腰椎椎体重建材料。

英文摘要:

  【Abstract】 Objective：To evaluate the short-term efficacy of the nano-hydroxyapatite/polyamide 66（n-HA/PA66）　implantation following anterior decompression for thoracolumbar burst fracture.Method：In this study，214 patients suffering thoracolumbar brust fracture received anterior decompression，n-HA/PA66 implantation and instrumentation from September 2007 to October 2010.There were 153 males and 61 females with the average age of 37.6 years（19-58 years）.The neurological function，X-ray and 3-dimensions CT（3D-CT）　scans at preoperative，1-week and ｆｉｎａｌ follow-up were reviewed retrospectively.The neurological function wａｓ analyzd according to Frankel criteria。Ｔhe Cobb angle and vertebra height and fusion status were reviewed.Result：188 patients were followed up for an average of 17.8m（6-36 months）.The preoperative neurological function included 20 Frankel A，38 B，59 C，47 D，24 E，and those at final follow-up included 17 A，9 B，20 C，46 D and 96 E.The mean Cobb angle　ａｔ　preoperatiｏｎ，1-week after operation and final follow-up was 17.5°，5.4°　and 5.7°respectively．Ｔhe means height of fractured vertebral body was 97.9mm before surgery，109.0mm 1　week after surgery and 108.4mm at final　follow-up with the mean loss of correction of 0.6mm.9 cases（4.8%）were complicated with prosthesis subsidence（loss of height≥2mm）.All cases had bony fusion rate of 96.3%，ａｎｄ　no deep infection or instrument failure was noted.Conclusion：The n-HA/PA66 implantation following anterior decompression is effective and reliable for thoracolumbar brust fracture，which has lower rate of subsidence and higher rate of bony union，and can be used for anterior vertebra reconstruction.