纳米羟基磷灰石/聚酰胺66复合生物活性支撑材料对椎体结构和高度的影响
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摘要
背景:纳米羟基磷灰石/聚酰胺66复合物在力学属性方面和人体皮质骨十分接近,且具有成骨活性,是一种安全可靠的骨材料。目的:探讨纳米羟基磷灰石/聚酰胺66复合生物活性支撑材料在恢复椎体结构和高度中的作用。方法:纳入177例脊柱疾病患者,其中男116例,女61例,年龄17-81岁,包括97例脊柱骨折、5例脊柱原发性肿瘤、17例脊柱结核及58例颈椎病,均实施前路减压纳米羟基磷灰石/聚酰胺66复合生物活性支撑体植骨融合内固定治疗。治疗后随访36个月,进行影像学分析、Frankel脊髓损伤分级、植骨融合、目测类比评分、JOA及SF-36评分评估。结果与结论:经随访,除1例颈椎骨折患者在术后出现轻微支撑体移位之外,其余患者均未出现支撑体脱出或破裂现象,植骨融合率为96.0%,平均支撑体下沉距离为1.7 mm;与治疗前比较,脊柱骨折97例患者治疗后的神经功能得到有不同程度改善(P<0.05);177例患者的目测类比评分、JOA评分及SF-36评分较治疗前显著改善(P<0.05)。表明在脊柱重建过程中使用纳米羟基磷灰石/聚酰胺66复合生物活性支撑材料可提高植骨融合率,有效恢复椎体结构和高度。
BACKGROUND: Nanohydroxyapatite/polyamide 66 composite is very close to the human cortical bone in terms of mechanical properties,and has osteogenic activity,which is a safe and reliable bone material. OBJECTIVE: To investigate the effect of nanohydroxyapatite/polyamide 66 composite bioactive supporting material on the restoration of vertebral structure and height. METHODS: Totally 177 patients with spinal diseases,116 males and 61 females,aged 17-81 years,were enrolled,including 97 cases of spinal fractures,5 cases of primary tumors of the spine,17 cases of spinal tuberculosis and 58 cases of cervical spondylosis. The nanohydroxyapatite/polyamide 66 composite bioactive supporting body was filled into the bone grafts of patients and then subjected to anterior decompression and internal fixation. After 36 months of follow-up,imaging analysis,Frankel spinal cord injury classification,bone graft fusion,visual analog scale scores,ShortForm 36 and Japanese Orthopedic Association scores were evaluated. RESULTS AND CONCLUSION: During the follow-up,except one patient with cervical spine fracture appeared to have slight supporting body displacement,there was no supporting body prolapse or rupture phenomena. The bone graft fusion rate was 96.0%,the average supporting body sinking distance was 1.7 mm. After treatment,97 patients with spinal fractures had different degree of improvement in the neurological function(P < 0.05); the visual analog scale scores,Short Form 36 and Japanese Orthopedic Association scores were improved significantly in all the 177 patients compared with before treatment(P < 0.05). These results demonstrate that the use of nanohydroxyapatite/polyamide 66 composite bioactive supporting material for spinal reconstruction can improve the bone fusion rate,and restore the vertebral structure and height effectively.
BACKGROUND: Nanohydroxyapatite/polyamide 66 composite is very close to the human cortical bone in terms of mechanical properties,and has osteogenic activity,which is a safe and reliable bone material. OBJECTIVE: To investigate the effect of nanohydroxyapatite/polyamide 66 composite bioactive supporting material on the restoration of vertebral structure and height. METHODS: Totally 177 patients with spinal diseases,116 males and 61 females,aged 17-81 years,were enrolled,including 97 cases of spinal fractures,5 cases of primary tumors of the spine,17 cases of spinal tuberculosis and 58 cases of cervical spondylosis. The nanohydroxyapatite/polyamide 66 composite bioactive supporting body was filled into the bone grafts of patients and then subjected to anterior decompression and internal fixation. After 36 months of follow-up,imaging analysis,Frankel spinal cord injury classification,bone graft fusion,visual analog scale scores,ShortForm 36 and Japanese Orthopedic Association scores were evaluated. RESULTS AND CONCLUSION: During the follow-up,except one patient with cervical spine fracture appeared to have slight supporting body displacement,there was no supporting body prolapse or rupture phenomena. The bone graft fusion rate was 96.0%,the average supporting body sinking distance was 1.7 mm. After treatment,97 patients with spinal fractures had different degree of improvement in the neurological function(P < 0.05); the visual analog scale scores,Short Form 36 and Japanese Orthopedic Association scores were improved significantly in all the 177 patients compared with before treatment(P < 0.05). These results demonstrate that the use of nanohydroxyapatite/polyamide 66 composite bioactive supporting material for spinal reconstruction can improve the bone fusion rate,and restore the vertebral structure and height effectively.
引文
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[27]修鹏,刘立岷,宋跃明,等.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[J].中国骨与关节外科,2009,2(5):347-351.
[28]Lina IA,Puvanesarajah V,Liauw JA,et al.Quantitative study of parathyroid hormone(1-34)and bone morphogenetic protein-2 on spinal fusion outcomes in a rabbit model of lumbar dorsolateral intertransverse process arthrodesis.Spine(Phila Pa 1976).2014;39(5):347-355.
[29]Elowitz EH,Yanni DS,Chwajol M,et al.Evaluation of indirect decompression of the lumbar spinal canal following minimally invasive lateral transpsoas interbody fusion:Radiographic and outcome analysis.Minim Invasive Neurosurg.2011;54(5-6):201-206.
[30]Mills B,Bach JR,Zhao C,et al.Posterior spinal fusion in children with flaccid neuromuscular scoliosis:The role of noninvasive positive pressure ventilatory support.J Pediatr Orthop.2013;33(5):488-493.
[31]Hui H,Luo ZJ,Yan M,et al.Non-fusion and growing instrumentation in the correction of congenital spinal deformity associated with split spinal cord malformation:An early follow-up outcome.Eur Spine J.2013;22(6):1317-1325.
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[2]蒋电明,权正学,欧云生,等.n-HA/PA66复合生物活性支撑材料在重建椎体结构中的初步临床应用[C].//2006中华骨科西部论坛论文汇编,2006:65-67.
[3]朱美忠.纳米羟基磷灰石/聚酰胺66复合人工椎体的实验验研究及初步临床应用[D].重庆医科大学,2007.
[4]黄伟,安洪,蒋电明,等.纳米羟基磷灰石/聚酰胺骨水泥增强骨质疏松松质骨性能的生物力学分析[J].中国临床康复,2006,10(1):53-56.
[5]胡炜,吴彦生,张斌,等.纳米羟基磷灰石/聚酰胺66复合生物活性材料构建的人工椎体治疗脊柱疾病[J].中国组织工程研究与临床康复,2010,14(38):7177-7180.
[6]杨曦,宋跃明,刘立岷,等.应用纳米羟基磷灰石/聚酰胺66椎体支撑体重建脊柱前柱的中期效果[J].中华外科杂志,2014,52(1):20-24.
[7]胡红涛.孔壁表现纳米化的n HA晶须增强多孔骨支架的制备与性能研究[D].第二军医大学,2012.
[8]吕超亮,宋跃明,刘浩,等.纳米羟基磷灰石/聚酰胺66椎体支撑体在下颈椎骨折脱位前路手术重建中的应用[J].中华外科杂志,2012,50(4):338-341.
[9]梁勇.纳米羟基磷灰石/聚酰胺66椎间融合器的实验研究[D].重庆医科大学,2007.
[10]何江涛.纳米羟基磷灰石/聚酰胺66复合生物活性人工椎体的极限生物力学及临床应用研究[D].重庆医科大学,2007.
[11]梁晟伟,黄民锋,王向鹏,等.人工椎体的组织相容性和力学性能[J].中国组织工程研究与临床康复,2011,15(26):4876-4879.
[12]张海兵.碳纳米管/羟基磷灰石/聚乳酸可降解椎间融合器实验研究[D].南方医科大学,2008.
[13]黄涛,吕刚.纳米骨材料的研究现状及临床应用[J].中国组织工程研究与临床康复,2007,11(1):194-196.
[14]陈日高,屠重琪,裴福兴,等.纳米羟基磷灰石/聚酰胺66复合物椎间融合器在山羊颈椎融合中的应用[J].中国脊柱脊髓杂志,2010,20(4):286-290.
[15]梁安靖,张新亮,彭焰,等.两种椎体替代物在重建颈椎稳定性时的疗效比较[J].中国医师进修杂志,2011,34(14):16-19.
[16]严宁.纳米羟基磷灰石聚酰胺材料用于山羊颈前路植骨的实验研究[D].第二军医大学,2009.
[17]高飞.兔腰椎间应用可注射型n-HA/Col骨材料融合效果的实验研究[D].北京中医药大学,2011.
[18]蒋电明,权正学,欧云生,等.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爆裂骨折中的应用[J].中华创伤杂志,2006,22(12):884-887.
[19]欧云生,蒋电明,权正学,等.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.
[20]王群波,蒋电明,安洪,等.纳米羟基磷灰石/聚酰胺66复合人工椎体在胸腰椎骨折中的应用[J].中华创伤杂志,2005,21(9):690-692.
[21]何斌,蒋电明,欧云生,等.纳米羟基磷灰石/聚酰胺66人工椎体置入与椎体重建[J].中国组织工程研究与临床康复,2010,14(47):8889-8892.
[22]孙麟,宋跃明,刘浩,等.纳米羟基磷灰石/聚酰胺66椎体支撑体在脊柱前柱手术重建中的应用[J].中国矫形外科杂志,2011,19(18):1497-1500.
[23]王高举,王清,王松,等.纳米羟基磷灰石/聚酰胺66复合生物活性人工椎体在骨质疏松性胸腰椎爆裂骨折前路手术中的应用[J].中国组织工程研究与临床康复,2009,13(38):7579-7582.
[24]Davis RJ,Errico TJ,Bae H,et al.Decompression and coflex interlaminar stabilization compared with decompression and instrumented spinal fusion for spinal stenosis and low-grade degenerative spondylolisthesis:Two-year results from the prospective,randomized,multicenter,food and drug administration investigational device exemption trial.Spine(Phila Pa 1976).2013;38(18):1529-1539.
[25]温从游,孟纯阳,蒋电明,等.纳米羟基磷灰石/聚酰胺66复合材料的研究及应用[J].中国组织工程研究,2014,18(3):464-469.
[26]陈豪,王利民,谭洪宇,等.比较纳米羟基磷灰石/聚酰胺66人工椎体与自体髂骨在颈椎前路减压融合中的应用[J].中国组织工程研究与临床康复,2011,15(12):2195-2198.
[27]修鹏,刘立岷,宋跃明,等.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[J].中国骨与关节外科,2009,2(5):347-351.
[28]Lina IA,Puvanesarajah V,Liauw JA,et al.Quantitative study of parathyroid hormone(1-34)and bone morphogenetic protein-2 on spinal fusion outcomes in a rabbit model of lumbar dorsolateral intertransverse process arthrodesis.Spine(Phila Pa 1976).2014;39(5):347-355.
[29]Elowitz EH,Yanni DS,Chwajol M,et al.Evaluation of indirect decompression of the lumbar spinal canal following minimally invasive lateral transpsoas interbody fusion:Radiographic and outcome analysis.Minim Invasive Neurosurg.2011;54(5-6):201-206.
[30]Mills B,Bach JR,Zhao C,et al.Posterior spinal fusion in children with flaccid neuromuscular scoliosis:The role of noninvasive positive pressure ventilatory support.J Pediatr Orthop.2013;33(5):488-493.
[31]Hui H,Luo ZJ,Yan M,et al.Non-fusion and growing instrumentation in the correction of congenital spinal deformity associated with split spinal cord malformation:An early follow-up outcome.Eur Spine J.2013;22(6):1317-1325.
[32]Mao K,Cui F,Li J,et al.Preparation of combinedβ-TCP/α-CSH artificial bone graft and its performance in a spinal fusion model.J Biomater Appl.2012;27(1):37-45.
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