纳米羟基磷灰石-聚酰胺66生物活性支撑体联合自体骨在颈前路重建中的应用

Anterior decompression and fusion with n-HA/PA66 composite artificial vertebral body and autogenous for the treatment of lower cervical spine injury

中文关键词:  纳米羟基磷灰石-聚酰胺  支撑体  自体骨  下颈椎损伤

英文关键词:Nano-hydroxyapatite/polyamide 66  Cage  Autogenous bone  Lower cervical spine injury

中文摘要:

  【摘要】 目的：评估纳米羟基磷灰石-聚酰胺66（n-HA/PA66）生物活性支撑体+自体骨应用于颈前路椎体次全切除减压融合内固定术治疗下颈椎损伤的临床效果，并与自体髂骨植骨进行对比。方法：回顾性研究2009年1月～2013年12月期间我院及兰州军区总医院收治的62例下颈椎损伤患者临床资料，损伤均为单一颈椎椎体骨折并颈髓损伤。入选的患者均行颈前路椎体次全切除减压椎间融合+前路钛板内固定术；根据术中支撑融合所用的植骨材料的不同，将患者分为2组：A组，应用自体髂骨植骨融合30例；B组，应用n-HA/PA66支撑体+自体骨植骨融合32例。比较两组的术中出血量、手术时间、并发症发生率；术后随访包括影像学评价及临床疗效评价，影像学评价以颈椎标准侧位X线片评估颈椎曲度、融合节段椎间高度及术后支撑体下沉率，以CT三维重建（3D CT）评估骨融合率；临床疗效评价采用JOA评分评价术后脊髓功能改善情况。结果：随访时间6～24个月，平均13±2.2个月。A组术中出血量及手术时间明显大于B组（P<0.05）。两组均无排斥反应出现，A组8例出现取骨区感染，16例出现取骨区疼痛、麻木不适；B组无术后并发症发生，A、B两组术后并发症发生率分别为80％及0％，两组间比较有统计学差异（χ2=17.12，P=0.00）；术后6个月两组的JOA评分较术前均明显改善（P<0.05），但术后6个月两组间比较JOA评分改善率无统计学差异（P>0.05）。术后6个月两组的骨性融合分别为A组100％，B组96.9％，两组融合率比较差异无统计学意义（P=0.20）；术后6个月两组的植骨下沉率分别为0％及3.1％（P=0.20），两组的术后植骨下沉率比较无统计学差异。两组手术前后的颈椎曲度矫正角度及椎间矫正高度比较，差异有统计学意义（P<0.05），而两组相对应时间点的组间比较，差异无统计学意义（P>0.05）。结论：纳米羟基磷灰石-聚酰胺66生物活性支撑体能有效恢复并维持颈椎融合节段生理高度及生理曲度，其骨融合率同自体髂骨相似，且不影响术后手术节段的影像学观察，是一种比较理想的颈椎前路重建植骨替代材料。

英文摘要:

  【Abstract】 Objectives: To study clinical effect and difference between the n-HA/PA66 composite artificial vertebral body and the iliac bone autograft in anterior cervical decompression and fusion for treatment of lower cervical spine injury. Methods: From January 2009 to December 2013, the clinical data of 62 patients with lower cervical spine injury(All damage in the patients with single cervical vertebral fracture combined with cervical spinal cord injury) were retrospectively analyzed. 62 cases of lower cervical spine injury were treated with anterior cervical subtotal corpectomy and fixed by titanium locking plates. According to the bone-grafting materials, the patients were divided into 2 groups: 30 cases implanted with iliac bone autograft(group A) and 32 with n-HA/PA66 composite artificial vertebral body and autogenous bone(group B). Blood loss in operation, operative time, complications after operation, prosthesis subsidence rate after operation were compared between two groups. The patients was followed up by imaging evaluation and clinical curative effect evaluation． Segmental height and sagittal lordosis were measured by radiographs. Instrument displacement and fusion status were assessed by 3D-CT images. Neurological function was followed up by improvement rate of JOA score. Results: 62 patients were followed up for an average of 13±2.2 months(6-24 months). Blood loss in operation and operative time of group A were significantly higher than those of group B(P<0.05). Iliac bone infection were observed in 8 cases of group A; pain and numbness at donor site occurred in 16 cases of Group A. There was no rejection reaction in the two groups. The incidence of postoperative complications of the two groups were 80％ and 0％. There was significant difference in complications between 2 groups(χ2=17.12, P=0.00). The JOA score at 6 months after operation significantly improved when compared with preoperative score in 2 groups(P<0.05), but no significant difference was found between two groups at preoperation and 6 months after operation(P>0.05). The graft fusion rate was 100% in group A and 96.9% in group B(P=0.20). 1 case(3.1%) were noted prosthesis subsidence(loss of height≥3mm) at 6 months in group B, and two groups of prosthesis subsidence showed no significant difference. Both segmental height and lordosis improved significantly after surgery in two groups(P<0.05). There was no significant difference between segmental height and lordosis of the two groups at the corresponding time points. Conclusions: The n-HA/PA66 composite artificial vertebral body can not only restore and maintain the fusion segmental height and lordosis, but also promote the osseous fusion and profit the radiographic assessment after operation. And the n-HA/PA66 composite artificial vertebral body was the same fusion rate as iliac bone autograft. Therefore, n-HA/PA66 composite artificial vertebral body can be taken as an ideal graft for anterior cervical spine reconstructive surgery.