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纳米羟基磷灰石/聚酰胺66复合生物活性人工椎体在胸腰椎骨折前路重建手术中的应用
引用本文:欧云生,蒋电明,权正学,安洪,刘渤.纳米羟基磷灰石/聚酰胺66复合生物活性人工椎体在胸腰椎骨折前路重建手术中的应用[J].中国修复重建外科杂志,2007,21(10):1084-1089.
作者姓名:欧云生  蒋电明  权正学  安洪  刘渤
作者单位:重庆医科大学附属第一医院骨科,重庆,400016
基金项目:国家高技术研究发展计划(863计划)
摘    要:目的探讨自行研制的纳米羟基磷灰石/聚酰胺66(nano-hydroxyapatite/polyamide 66,n-HA/PA66)复合生物活性人工椎体在胸腰椎骨折前路手术重建伤椎结构和高度的临床疗效。方法 2003年12月~2006年1月,对42例胸腰椎骨折行前路减压、n-HA/PA66复合生物活性人工椎体支撑植骨、钛钉板或钉棒系统内固定脊柱前路重建手术。其中男28例,女14例。年龄17~67岁,平均43.6岁。胸腰椎爆裂骨折的损伤节段:T125例、L117例、L214例、L36例。椎体前缘高度为椎体的29%~47%,平均40.6%。矢状面Cobb角为21~38°,平均27.6°。术前神经损害Frankel分级:A级7例、B级19例、C级8例、D级6例、E级2例。结果所有患者术后均获得随访6~25个月,平均13个月。36例伤椎近解剖复位,6例复位良好。术后伤椎前缘高度为椎体的87%~96%,平均91.7%,重建的椎体高度无丢失。术后矢状面Cobb角为9.5~18.5°,平均13.4°。Frankel神经功能分级:除7例A级及2例D级无变化外,其余均有1~2级的改善。n-HA/PA66复合生物活性人工椎体于术后3~5个月骨性融合。无感染、椎体移位和断钉等并发症。结论 n-HA/PA66复合生物活性人工椎体能有效恢复和维持伤椎的结构和高度,重建脊柱的稳定性,并能与邻近椎体骨性融合。

关 键 词:纳米羟基磷灰石  聚酰胺66  生物材料  脊柱骨折  外科手术
修稿时间:2006-07-10

Application of Artificial Vertebral Body of Biomimetic Nano-Hydroxyapatite/Polyamide 66 Composite In Anterior Surgical Treatment of Thoracolumbar Fractures
OU Yunsheng,JIANG Dianming,QUAN Zhengxue,AN Hong,LIU Bo.Application of Artificial Vertebral Body of Biomimetic Nano-Hydroxyapatite/Polyamide 66 Composite In Anterior Surgical Treatment of Thoracolumbar Fractures[J].Chinese Journal of Reparative and Reconstructive Surgery,2007,21(10):1084-1089.
Authors:OU Yunsheng  JIANG Dianming  QUAN Zhengxue  AN Hong  LIU Bo
Institution:Department of Orthopaedics, First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, P. R. China.
Abstract:OBJECTIVE: To study the clinical effects of the artificial vertebral body of the biomimetic nano-hydroxyapatite/ polyamide 66 (n-HA/PA66) composite for the structural reconstruction and the height restoring of the vertebral body in the thoracolumbar fractures by the anterior surgical procedures. METHODS: From December 2003 to January 2006, 42 patients with thoracolumbar fractures received the anterior surgical procedures to decompress and reconstruct the spinal vertebral structure with the artificial vertebral body of the n-HA/PA66 composite. Among the patients, there were 28 males and 14 females, aged 17-67 years, averaged 43.6 years. The thoracolumbar fractures developed at T12 in 5 patients, at L1 in 17, at L2 in 14, and at L3 in 6. The height of the anterior border of the vertebral body amounted to 29%-47% of the vertebral body height, averaged 40.6%. The Cobb angle on the sagittal plane was 21-38 degrees averaged 27.6 degrees. According to the Frankel grading scale, the injuries to the nerves were as the following: Grade A in 7 patients, Grade B in 19, Grade C in 8, Grade D in 6, and Grade E in 2. RESULTS: All the 42 patients were followed up for 6-25 months. Among the patients, 36 were reconstructed almost based on the normal anatomic structure, and 6 were well reconstructed. The mean height of the anterior border of the vertebral body was 40.6% of the vertebral body height before operation but 91.7% after operation. And the reconstructed height of the vertebra was maintained. The mean Cobb angle on the sagittal plane was 27.6 degrees before operation but 13.4 degrees after operation. All the patients had a recovery of the neurological function that had a 1-grade or 2-grade improvement except 7 patients who were still in Grade A and 2 patients who were in Grade D. The implant was fused 3-5 months after operation. No infection, nail break, bar/ plate break or loosening of the internal fixation occurred. CONCLUSION: The artificial vertebral body of the biomimetic n-HA/PA66 composite can effectively restore the height and the structure of the vertebra, can be fused with the vertebral body to reconstruct the spinal structural stability effectively, and can be extensively used in the clinical practice.
Keywords:Nano-hydroxyapatite Polyamide 66 Biomaterial Spinal fracture Operative surgical procedure
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