纳米羟基磷灰石/聚酰胺66复合生物活性人工椎体在骨质疏松性胸腰椎爆裂骨折前路手术中的临床体会

目的:探讨纳米羟基磷灰石/聚酰胺66复合生物活性人工椎体在骨质疏松性胸腰椎爆裂骨折前路手术中应用的手术要点与经验。方法:回顾我院21例骨质疏松性胸腰椎爆裂骨折经前路减压、植骨融合内固定手术病例,从椎管减压、脊柱稳定性重建方法及效果方面,总结手术经验。结果:21例均获得随访,随访时间7个月以上,显示手术后胸腰椎生理曲度恢复满意,CT/MRI复查,椎管容积扩大,致压骨块消失,植入人工纳米羟基磷灰石/聚酰胺66复合生物活性人工椎体已与相邻椎体融合,神经功能恢复(Frankel分级)提高1²级。术中无较大副损伤出现,术后未发生钛合金板与螺丝钉松动、断裂等并发症。结论:骨质疏松性胸腰椎爆裂骨折前路减压彻底,重建方式符合脊柱生物力学分布原则,脊髓功能恢复较好,通过改进内固定技术及支撑材料后,无内固定松动、断裂等并发症,远期脊髓神经再压迫风险小。

Clinical experience of application of nano-hydroxyapatite or polyamide 66 composite bioactive artificial vertebrae in anterior approach of osteoporotic thoracolumbar burst fracture

Objective：To summarize the surgical precautions and experience of application of nano-hydroxyapatite or polyamide 66 composite bioactive artificial vertebrae in anterior approach of osteoporotic thoracolumbar burst fracture.Methods：21 patients with osteoporotic thoracolumbar burst fractures who underwent anterior decompression and bone graft fusion with internal fixation were retrospectively reviewed.The surgical experiences were concluded based on the construction methods and effects of spinal canal decompression and spinal stability.Results：The follow-up activities were done among the 21 patients for more than 7 months,showing a satisfactory horacolumbar physiological curvature.Postoperative CT/MRI review demonstrated that spinal canal volume was expanded and the compressive bone disappeared.Nano-hydroxyapatite or polyamide 66（n-HA,PA66） bioactive artificial vertebrae were fused with adjacent vertebral body,and the nervous function（according to Frankel grade） improved 1～2 degree.No major iatrogenic injuries occurred and no rod break or screw shift was observed after the surgery.Conclusion：The complete decompression and reconstruction of osteoporotic thoracolumbar burst fracture conform to the principles of structural property distributions;the spinal cord function was improved satisfactorily.Through the improvement of fixed technology and supported material,no complication of loosening or fracture of internal fixation occurred and there was a low risk of long-term recurrent spinal decompression.