多孔纳米羟基磷灰石-聚酰胺66椎间融合器治疗胸腰椎爆裂骨折的早期临床研究

目的 评价多孔纳米羟基磷灰石-聚酰胺66椎间融合器(n-HA/PA66 cage)治疗胸腰椎爆裂骨折的早期临床效果.方法 2008年1月至2008年9月,对54例胸腰椎爆裂骨折患者采用前路减压多孔n-HA/PA66 cage支撑植骨融合固定治疗.术前、术后1周内、3、6个月、1年随访时进行随访,用Frankel法记录患者神经功能,并行X线片及三维CT检查.采用Cobb法测最后凸情况,并测最伤椎邻近上、下椎体间高度,采用Brantigan等描述的方法观察融合情况.结果 术后无神经损害加重;除2例Frankel A级和8例D级患者外,其余患者神经功能均有1～2级的恢复.平均随访9.4个月(6～12个月).术前平均矢状位后凸角14.4°±12.6°,术后为3.7°±8.7°,末次随访时3.9°±8.5°.术前平均伤椎邻近上、下椎体间高度为(96.9±17.2)mm,术后为(109.5±17.1)mm,末次随访时为(108.6±16.9)mm.随访期间未见cage移位、内同定断裂及神经功能损害加重.19例达到E级融合,10例达到D级融合,25例达到C级融合.结论 前路减压多孔n-HA/PA66 cage支撑植骨融合固定治疗胸腰椎爆裂骨折安全可行,术后椎间高度恢复满意,后凸畸形纠正明显,随访过程中丢失少,并能获得满意融合.

The preliminary clinical outcomes of porous nano-hydroxyapatite polyamide 66 cage in the trearment of thracolumbar burst fracture

Objective To evaluate the early clinical outcomes of porous nano-hydroxyapatite polyamide 66 cage in the treatment of thoracolumbar burst fracture. Methods From Jan 2008 to Sep 2008, 54 patients with thoracolumbar burst fracture were treated by anterior thoracolumbar body resection com-bined with nano-hydroxyapatite polyamide 66 cage fusion. All patients were evaluated preoperatively, post-operatively and 3, 6, 12 months postoperatively. The neurological function were measured by Frankel grade. All of the patients underwent X ray and three-dimensional CT scan. The Cobb angle were used to measured the kyphosis of the fusion segments. The intervertebral fusion were graded by criterion described by Branti-gan. Results The mean follow-up period was 9.4 month. No patients had deteriorated neurologically and all improved at least one neurologic grade, except 2 patients with Franke rank A and 8 patients with Franke rank D. The mean preoperative kyphosis has improved from 14.4°to 3.7° immediately after surgery and 3.9° at the final follow-up. The mean preoperative distance between adjacent vertebral bodies was (96.9±17.2)mm preoperatively, (109.5±17.1) mm immediately after surgery and (108.6±16.9) mm at the final follow-up. No cage displacement, internal fixation breakage or neurologie impairment were found. At the final follow-up, 19 patients had achieved grade E fusion, 10 achieved grade D, and 25 achieved grade C. Conclusion The present study demonstrates Anterior decompression combined with porous nano-hydroxyapatite polyamide 66 cage fusion was a effective method to treat thoracolumbar burst fracture. The kyphosis the intervertebral dis-tahoe was corrected effectively with a low rate of instrumentation failure and loss of correction and interver-tebral distance.