纳米羟基磷灰石/聚酰胺66复合生物活性人工椎板的初步临床应用

目的探讨自行研制的纳米羟基磷灰石/聚酰胺66（nano-hydroxyapatite/polyam ide66,n-HA/PA66）复合生物活性人工椎板,在防止椎管内瘢痕粘连及重建椎管后部结构中的作用。方法2003年1月~2005年12月,采用n-HA/PA66复合生物活性人工椎板治疗椎板切除术后椎板缺损23例。男16例,女7例;年龄48-76岁,平均59岁。椎管狭窄11例,椎管狭窄伴脊椎滑脱7例,椎间盘突出3例,脊柱肿瘤2例。病变节段：C5、6、L1及L2各1例,L4、55例,L4-S19例,L5、S16例。20例使用1个人工椎板,3例使用2个人工椎板。结果术后1例伤口感染,经对症处理后愈合,余22例伤口期愈合。23例均获5-24个月随访。1例L4、5中央型椎间盘突出患者因术中过度牵拉造成术后神经根损害症状加重,其余患者腰腿痛症状均缓解,无明显排斥反应。CT检查示椎管扩大;MRI示椎管内瘢痕形成及粘连均不明显;CT及三维重建示术后3-6个月人工椎板与受体骨接触界面模糊,间隙消失。结论新型n-HA/PA66复合生物活性人工椎板,可有效防止外源性瘢痕压迫神经根及硬膜囊,有效恢复椎管结构。

PRIMARY CLINICAL APPLICATION OF ARTIFICIAL VERTEBRAL LAMINAE OF THE BIOMIMETIC NANO-HYDROXYAPATITE/POLYAMIDE 66 COMPOSITES

Objective To study the clinical effects of artificial vertebral laminae of the biomimetic nano-hydroxyapatite/polyamide 66(n-HA/PA66)composites in prevention of the scar formation in lumbar spinal canal and the reconstruction of posterior vertebral laminae structure.Methods From January 2003 to December 2005,23 patients were treated with artificial vertebral laminae of the biomimetic n-HA/PA66 composites.There were 16 males and 7 females,aging from 48 to 76 years with an average of 59 years.Of 23 cases,11 cases had spinal stenosis,7 cases had spinal stenosis with spondylolysis,3 cases had lumbar disk herniation and 2 cases had spinal tumor.Twenty cases of vertebral laminae were reconstructed by 1 artificial vertebral laminae and 3 cases by 2.The affected locations were C5,6,L1 and L2 in 1 case respectively;L4,5 in 5 cases;L4-S1 in 9 cases;and L5,S1 in 6 cases.Results First intension was achieved in 22 cases and infection occured in 1 case.In the period of follow-up for all cases lasted from 5 to 24 months,the postoperative CT showed that the n-HA/PA66 artificial vertebral laminae enlarged the spinal canal.MRI showed little scar formation and adhesion in the lumbar spinal canal.CT showed ill-defined boundary between artificial vertebral laminae and recipient vertebral laminae.No neural symptoms occured in all cases except one because of stretch injury of nerve root in operation.Also no rejection reaction was observed.Conclusion The artificial vertebral laminae of the biomimetic n-HA/PA66 composites can effectively prevent the compression to the nerve root and dural sac from the scar and restore the vertebral laminae.