【摘要】 目的探讨纳米羟基磷灰石/聚酰胺66(nano-hydroxyapatite polyamide 66,n-HA/PA66)椎体支撑体在儿童脊柱结核前柱重建手术中的临床效果。方法 2008年1月~2015年12月应用n-HA/PA66椎体支撑体行儿童脊柱结核病灶清除前柱重建手术23例,其中胸椎结核9例,胸腰段脊柱结核9例,腰椎结核5例。术前神经功能按Frankel分级:D级14例,E级9例。采用VAS评分、Frankel神经功能分级评估手术疗效,通过X线片及三维CT评价术后脊柱序列恢复、支撑体融合及移位下沉情况。结果 23例均获随访,平均随访时间12.6(9~36)个月。术后患者疼痛明显缓解,VAS评分由术前平均(7.2±1.3)分下降至末次随访时(1.8±1.1)分,手术前后比较差异有统计学意义(P<0.05)。术后结核症状消失,病灶完全治愈,无复发。术前14例合并神经功能障碍的D级患者均恢复到E级。病椎后凸Cobb角由术前平均45.2°±2.5°矫正至28.3°±2.6°,手术前后比较差异有统计学意义(P<0.05)。均无支撑体脱出、破裂、塌陷等情况出现。术后9个月植骨融合率为100%,复查X线及三维CT示4例椎体支撑体出现轻微下沉,但n HA/PA66椎体支撑体与相邻椎体终板间均达到骨性融合,内固定位置良好。结论 n-HA/PA66椎体支撑体能有效恢复及维持融合节段的生理高度及弧度,促进植骨融合,是一种儿童脊柱结核病灶清除脊柱前柱重建手术的理想支撑及植骨材料。更多还原

【Abstract】 Objective To evaluate the clinical effect of nano-hydroxyapatite/polyamide 66(n-HA/PA66)cage in the anterior spinal reconstructive surgery for spinal tuberculosis in children. Methods A total of 23 children with spinal tuberculosis from January 2008 to December 2015 were performed anterior focus debridement and spinal reconstructive surgery by n-HA/PA 66 cage combined with spinal internal fixators. The tuberculosis located in thoracic vertebrae in 9 cases,thoracolumbar vertebrae in 9 cases and lumbar vertebrae in 5 cases. The preoperative Frankel classification was grade D in 14 cases and grade E in 9 cases. Results All 23 were followed up for 9 to 36 months with an average of 12.6 months. The pain was relieved with the VAS sore decreasing from 7.2±1.3 preoperatively to 1.8±1.1 postoperatively(P<0.05). The symptom of tuberculosis was disappeared and the lesion was cured completely without recurrence. 14 cases with incomplete paraplegia restored from grade D to grade E of Frankel neurological classifications. The Cobb angle of involved vertebrae was corrected from 45.2°±2.5° preoperatively to 28.3°±2.6° postoperatively(P<0.05). There was no cage emersion,rupture and collapse in all cases. The fusion rate achieved 100% nine months after the surgery. The X-ray and 3 D-CT showed slight sedimentation of the cage in 4 cases,but well bone fusion was achieved between the imbedded cage and terminal plate of adjacent vertebral body and internal fixation was reliability in all cases.Conclusion The n-HA/PA 66 cage can restore and maintain the fusion segmental height and improve the bone graft fusion,and it is an ideal shoring and grafting material in the anterior spinal reconstructive surgery for spinal tuberculosis in children.更多还原