纳米羟基磷灰石／聚酰胺66复合生物活性人工椎板的长期疗效分析

背景：腰椎管狭窄症患者行全椎板切除后可能导致术后腰椎失稳，而且椎板缺损区易形成大量的瘢痕组织，与硬膜及神经根粘连，牵扯、压迫、卡压神经而引起严重的疼痛。目的：探讨纳米羟基磷灰石／聚酰胺66（nano-hydroxyapatite／polyamide 66，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长期疗效。方法：对2003年1月至2005年12月采用n-HA／PA66复合生物活性人工椎板重建椎板切除术后椎板缺损12例进行随访。男8例，女4例；年龄41～73岁，平均56岁。重建节段：L21例，L33例，L44例，L4-L52例，L52例。10例使用1个人工椎板，2例使用2个人工椎板。分别在术前、术后3个月及末次随访时采用JOA评分从主观症状、临床体征、日常活动受限情况及膀胱功能等方面对疗效进行评价，并通过影像学检测椎管矢状径变化。结果：12例患者获7～9年随访。术前、术后3个月、末次随访时JOA评分分别为（12．36±3．20）、（25．09±2．07）、（27．73±0．65）分；腰椎管狭窄节段术前椎管矢状径为（13．7±0．9）mm，末次随访时为（33．9±1．8）mm。术前、术后JOA评分和椎管矢状径相比较，差异有统计学意义（P〈0．05）。末次随访时，腰椎正侧位X线片示内固定在位，无松动及断裂情况；CT检查示椎管明显扩大，形态良好，未见塌陷；CT三维重建示人工椎板与骨接触面愈合良好，椎管后壁结构完整、稳定；MRJ示椎管内无明显瘢痕形成，神经根、硬膜囊膨胀良好。按JOA评分标准：优10例，良2例。结论：n-HA／PA66复合生物活性人工椎板能有效防止椎管内瘢痕形成，恢复椎管结构。

Long-term follow-up results of nano-hydroxyapatite/polyamide 66 composite material artificial vertebral lamina

Background： Laminectomy may result in postoperative lumbar instability and formulation of scar tissue in the defect area of vertebral plate. It often leads to postoperative epidural adhesions that cause well-recognized complications in the lumbar spine failed back surgery syndrome. Objective： To study the long-term clinical effects of the nano-hydroxyapatite/polyamide -66 （n-HA/PA66） composite material artificial vertebral lamina on preventiong the scar formation in the spinal canal, and reconstructing vertebral canal posterior structure. Methods： From January 2003 to December 2005, 12 patients were treated with artificial vertebral plate made of n-HA/PA66 composite material. There were 8 males and 4 females with an average age of 56 years （range, 41 to 73 years）. Reconstruction segments： 1 case in L2, 3 cases in L3, 4 cases in L4, 2 cases in Ls, and 2 cases in both L4 and L5. One artificial vertebral plate was applied in 10 patients and 2 plates were used in 2 patients. Clinical outcomes were assessed by JOA score preoperatively, 3 months postoperatively, and at the final follow-up, which included subjective symptom, clinical sign, restricted conditions for daily activities and bladder function. The changes of vertebral canal sagittal diameter were measured through imaging examination. Results： All 12 patients had been followed up prospectively for 7 to 9 years. The JOA scores were 12.36±3.20, 25.09±2.07 and 27.73±0.65 before operation, 3 months after operation, and at the final follow-up, respectively. The sagittal diameter of narrow segment was （13.7±0.9） mm and （33.9±1.8） mm before operation and at the final follow-up. There was significant difference in JOA scores and vertebral canal sagittal diameter before operation and after operation （P〈0.05）. X-ray and CT showed that the vertebral canal had no stenosis and collapse, the rebuilt vertebral laminae fused well at the last follow-up. The internal fixation had no failure. MRI showed little scar formation and adhesion in the lumbar spinal canal. Ten cases obtained excellent results and two got good results by JOA scoring. Conclusions： The n-HA/PA66 composite material artificial vertebral plate can effectively prevent the compression to the nerve root and dural sac from the scar and restore the vertebral laminae.