n-HA/PA66复合人工椎体支撑植骨在后路胸腰椎结核术中的应用

摘要

目的 探讨后路胸腰椎结核手术中纳米羟基磷灰石/聚酰胺66(n-HA/PA66)复合人工椎体支撑植骨的临床疗效.方法 回顾性分析2011年10月至2014年10月我科收治的胸腰椎结核(T5~S1)病人39例,年龄为29~68岁,平均为(47.6±12.5)岁.其中胸椎结核9例,胸腰段结核19例,腰椎结核11例.对病人的手术时间、术中出血量及手术前后脊柱后凸角(Cobb角)、疼痛视觉模拟量表(vi-sual analogue scale,VAS)评分、红细胞沉降率(erythrocyte sedimentation rate,ESR)、美国脊柱损伤协会(American Spinal Injury Association,ASIA)脊髓损伤分级、植骨融合情况等进行分析,评价手术治疗的效果及远期疗效.结果 术后39例病人中有1例失访,38例获得随访,随访时间为12~24个月,平均为(17.5±4.1)个月.所有病人手术均无神经功能损伤等严重并发症发生,无结核复发,切口均甲级愈合.平均手术时间为(176.0±30.5)min,术中平均出血量为(800.0±80.5)ml;手术前后Cobb角、VAS评分、ESR等比较,差异均有统计学意义(均P<0.05).所有病人末次随访显示植骨融合,ASIA分级较术前明显改善.结论 后路胸腰椎结核病灶清除n-HA/PA66复合人工椎体支撑植骨手术时间短、并发症少、矫形效果明显、融合率高,是一种安全、有效的治疗方法.%Objective To evaluate the clinical effect of biocomposite artificial vertebral body of nano-hydroxyapatite/polyamide 66 (n-HA/PA66) in the treatment of posterior thoracolumbar tuberculosis. Methods Thirty-nine cases of the thoracic and lumbar spinal tuberculosis (T5-S1) were studied retrospectively from October 2011 to October 2014. They were 29-68 years old. There were 9 cases of thoracic tuberculosis, 19 cases of thoracolumbar and 11 cases of lumbar tuberculosis. The operation time, intraoperative blood loss, Cobb angle, visual analogue scale (VAS), erythrocyte sedimentation rate (ESR) and American Spinal Injury Associa-tion (ASIA) classification were evaluated. Results In all cases, only 38 cases were followed up for 12 to 24 months[average, (17.5±4.1) months]. During the follow-up period, there were no neurovascular injury, no severe complication and no tuberculosis recurrence, and incision grade A healing was noted. The average operation time was 176.0 ± 30.5 min, and the average blood loss was 800.0 ± 80.5 ml. There were significant differences in Cobb angle, VAS and ESR (all P<0.05). All patients had bone graft fusion and the ASIA grading was significantly improved as compared with preoperation. Conclusion Posterior debridement and implanta-tion with biocomposite artificial vertebral body of n-HA/PA66 had advantages of shorter operation time, less complications, higher fusion rate and more obvious orthopedic effects, and it is effective for the thoraco lum-bar tuberculosis.