纳米羟基磷灰石／聚酰胺66椎体支撑体在脊髓型颈椎病前路手术重建中的应用

目的探讨纳米羟基磷灰石／聚酰胺66（nano—hydroxyapatite polyamide66，n—HA／PA66）椎体支撑体在脊髓型颈椎病前路减压，脊柱稳定性重建中的可行性及优点。方法2008年8月至2009年5月，行前路椎间盘切除或椎体次全切除、椎管减压，以n—HA／PA66椎体支撑体支撑植骨、钢板螺钉内固定治疗24例脊髓型颈椎病患者，男18例，女6例；年龄44～72岁，平均58．6岁。随访以日本矫形外科学会（Japan Orthopaedic Assoctiation，JOA）评分改善率评价患者神经功能恢复情况，复查X线片及三维CT评估支撑植骨融合情况，包括椎间高度、生理弧度及支撑体下沉。结果24例患者均成功完成颈椎前路减压手术以及支撑体的安放固定，并获得随访，随访时间3～9个月，平均5．6个月，所有患者的术前症状均得到不同程度的改善，术后3、6、9个月的JOA改善率分别为78．8％、83．4％、83．3％。影像学检查显示所有患者植骨融合，颈椎序列、椎间高度、颈椎稳定性以及支撑体的位置维持良好，人工椎体无下沉、移位。结论n—HA／PA66椎体支撑体具有早期支撑稳定功能，可有效维持颈椎生理序列和椎间高度；术后植骨融合率高且便于X线片观察，是进行颈椎退变前路手术植骨的理想支撑材料，但长期效果需进一步随访观察。

Application of n-HA/PA66 composite artificial vertebral body in anterior reconstruction of cervical spondylotic myelopathy

Objective To initially evaluate the application of artificial vertebra of n-HA/PA66 in anterior reconstruction of cervical spondylotie myelopathy. Methods In this study, 24 patients with cervical spondylotie myelopathy received anterior cervical discectomy, spinal canal decompression or subtotal corpectomy, spinal canal decompression and reconstruction by n-HA/PA66 composite artificial vertebral body combined with plate instrumentation. Neurological function was followed up by improvement rate of JOA score and situations of the supporting body was observed by X ray and 3D-CT in 3, 6, 9 months postoperatively. The intervertebral height, physical arc （reflected by Cobb angle） and the locations and fusion rate of the supporting body were assessed in order to evaluate the stability of the cervical spine and alignment improvements. Results All the patients underwent operation successfully and were followed up for 3 to 9 months with an average of 5.6 months. The preoperative symptoms were improved to varying degrees. JOA improvement rate were 78.8%, 83.4%, 83.3% 3, 6, 9 months after operation, respectively. Imaging studies showed that in all cases graft fusion were achieved, and cervical alignments, intervertebral height, cervical spine stability and the locations of the artificial vertebral body were well maintained. No displacement and subsidence of the artificial vertebral body occurred. Conclusion n-HA/PA66 artificial vertebral body can provide early cervical spine support and stability and effectively maintain the biological alignment and cervical intervertebral height. It has high rate of graft fusion and is convenient to observe by X-ray. Therefore, n-HA/PA66 can be taken as an ideal graft for anterior degenerative cervical spine operation, but further follow-up study is still required to evaluate the long-term effects.