前路减压n-HA/PA66支撑体植骨融合术治疗下颈椎骨折脱位的临床观察

目的：探讨前路减压、纳米羟基磷灰石／聚酰胺66（n-HA／PA66）支撑体植骨融合内固定术治疗下颈椎骨折脱位的中期临床效果。方法：回顾性分析2008年1月至2010年12月应用n-HA／PA66支撑体行植骨融合术治疗的42例下颈椎骨折脱位患者的临床资料，其中男29例，女13例；年龄20～65岁，平均46．8岁。损伤节段：C35例，C414例，C，12例，C67例，C74例。伤后神经功能损伤按Frankel分级：A级4例，B级11例，C级13例，D级9例，E级5例。28例行前路伤椎次全切减压，14例行椎问盘切除减压。根据FrankeⅠ分级评估神经功能恢复程度；依据疼痛视觉评分（VAS）评价临床症状改善情况；通过颈椎侧位X线片评估融合节段高度以及前凸角度；通过三维CT评估支撑体位置、外形以及植骨块融合情况。结果：42例均获随访，时间3-5．2年，平均4．1年。术后神经功能Frankel分级：A级2例，B级3例，C级11例，D级8例，E级18例，较术前明显改善（Z=-4．845，P〈0．001）。术后3d及朱次随访时VAS评分分别为2．6±1．8和1．3±1．0，均较术前改善（P〈0．05）。无支撑体脱出、塌陷、破裂等情况出现。末次随访时，1例患者（2．4％）支撑体轻微移位（〈2mm），总体植骨融合率为97．6％（40／41）。患者术后融合节段高度及前凸角度较术前有明显提高（P〈0．001），但术后各时间点之间差异无统计学意义（P〉0．05）。支撑体下沉距离平均为（1．5±1．1）mm，下沉率（下沉距离〉3m）为4．8％。结论：n-HA／PA66支撑体能有效恢复及维持融合节段生理高度及弧度，促进植骨融合，方便术后手术节段的影像学观察，是一种较为理想的颈椎前路支撑植骨材料。

Anterior decompression and fusion with n-HA/PA66 cage for the treatment of lower cervical fracture and dislocation also promote the osseous fusion and profit the radiographic assessment after operation

Objective: To explore the clinical effects of anterior decompression and fusion with a nano-hydroxyapatite/polyamide 66 (n-HA/PA66) cage in treating lower cervical fracture and dislocation. Methods: From January 2008 to December 2010,the clinical data of 42 patients with lower cervical fracture and dislocation were retrospectively analyzed. There were 29 males and 13 females aged from 20 to 65 years old. The mean age was 46.8 years. Five cases got injuried in C₃,14 cases in C₄,12 cases in C₅,7 cases in C₆ and 4 cases in C₇. According to Frankel grade,4 cases were classified in grade A,11 cases in grade B,13 cases in grade C,9 cases in grade D and 5 cases in grade F. Twenty-eight cases were treated with anterior corpectomy and fusion and 14 cases with anterior discectomy and fusion. Frankel grade was used to do neurologic assessment and visual analogue scale(VAS) was used to evaluate the improvement of clinical symptoms. Segmental height and sagittal lordosis were measured by radiographs and cage location. Cage appearance and fusion status were assessed by 3D-CT images. Results: All patients were followed up for 3 to 5.2 years with an average of 4.1 years. Frankel grade had obviously improved than preoperative (Z=-4.845,P<0.001). There were 2,3,11,8,11 cases classified in grade A,grade B,grade C,grade D and grade E respectively. At the third day after operation and latest follow-up,VAS was (2.6±1.8),(1.3±1.0) scores respectively. Both had improved than preoperative(P<0.05). Up to the latest follow-up,there was only one patient(2.4%) with slight cage translocation (less than 2 mm),however,no cage prolapsed,or collapse,or breakage were found. Both segmental height and lordosis improved significantly after surgery(P<0.001). And there was not significant difference in both parameters between each postoperative time points (P>0.05). The mean distance of cage subsidence was 1.5 mm and the rate of cage subsidence (>3 mm) was 4.8%. Conclusion: The n-HA/PA66 cage can not only restore and maintain the fusion segmental height and radian,but