• 四川大學(xué)華西醫(yī)院骨科（成都，610041）;

目的 評價使用納米羥基磷灰石/聚酰胺66（nano-hydroxyapatite/polyamide-66，n-HA/PA66）椎間融合器行椎間融合術(shù)治療下腰椎退變性疾病的近期療效。 方法2011年1月－10月，對20例下腰椎退變性疾病患者行經(jīng)椎間孔入路n-HA/PA66椎間融合器支撐植骨融合內(nèi)固定術(shù)治療。男8例，女12例；年齡22～80歲，平均51歲。病程1～24個月，平均4個月。手術(shù)融合節(jié)段：L4、5 8例，L5、S1 9例，L4～S1 3例。腰椎間盤突出癥術(shù)后復(fù)發(fā)3例，腰椎退變性滑脫癥5例，腰椎峽部裂滑脫癥9例，腰椎管狹窄癥3例。手術(shù)前后行X線片及CT三維重建檢查，測量患者融合節(jié)段椎間隙高度及前凸曲度以評價手術(shù)效果，觀察植骨融合情況。采用Oswestry功能障礙指數(shù)（ODI）下腰痛評分及簡明健康調(diào)查量表（SF-36）評分評價患者癥狀改善情況。 結(jié)果術(shù)后患者切口均Ⅰ期愈合，腰腿疼痛、麻木等癥狀均有不同程度緩解，未出現(xiàn)腦脊液漏、神經(jīng)根損傷、傷口感染等并發(fā)癥。20例均獲隨訪，隨訪時間6～9個月，平均7個月。未發(fā)生椎間融合器移位、塌陷等情況。術(shù)后3 d，3、6個月及末次隨訪時所有融合節(jié)段的椎間隙高度及前凸曲度均較術(shù)前顯著改善（P  lt; 0.01）；術(shù)后各時間點間比較，差異均無統(tǒng)計學(xué)意義（P  gt; 0.05）。椎間植骨融合時間3～9個月，平均4個月。術(shù)后3個月椎間植骨融合率為74%，術(shù)后6個月為96%?；颊咝g(shù)后3 d及6個月時的ODI及SF-36評分均較術(shù)前顯著提高（P  lt; 0.01），術(shù)后兩時間點間比較，差異無統(tǒng)計學(xué)意義（P  gt; 0.05）。 結(jié)論應(yīng)用n-HA/PA66椎間融合器行椎間融合術(shù)治療下腰椎退變性疾病安全有效；n-HA/PA66椎間融合器具有植骨融合率高、下沉率低及透射X線等優(yōu)點，是一種較為理想的椎間支撐植骨材料，但遠期療效有待進一步觀察。

引用本文： 楊曦,宋躍明,孔清泉,龔全,裴福興,屠重棋. 納米羥基磷灰石/聚酰胺66椎間融合器植骨融合治療下腰椎退變性疾病的近期療效. 中國修復(fù)重建外科雜志, 2012, 26(12): 1425-1429. doi: 復(fù)制

1. Harms JG, Jeszenszky D. The unilateral, transforaminal approach for posterior lumbar interbody fusion. Orthop Traumatol, 1998, 6: 88-99.
2. Rosenberg WS, Mummaneni PV. Transforaminal lumbar interbody fusion: technique, complications, and early results. Neurosurgery, 2001, 48(3): 569-574.
3. Lowe TG, Tahernia AD, O’Brien MF, et al. Unilateral transforaminal posterior lumbar interbody fusion (TLIF): indications, technique, and 2-year results. J Spinal Disord Tech, 2002, 415(1): 31-38.
4. Moskowitz A. Transforaminal lumbar interbody fusion. Orthop Clin North Am, 2002, 33(2): 359-366.
5. Chastain CA, Eck JC, Hodges SD, et al. Transforaminal lumbar interbody fusion: a retrospective study of long-term pain relief and fusion outcomes. Orthopedics, 2007, 30(5): 389-392.
6. 薛華明, 涂意輝, 蔡珉巍, 等. 單側(cè)TLIF聯(lián)合單側(cè)椎弓根釘內(nèi)固定治療腰椎退變疾患的臨床研究. 中國矯形外科雜志, 2010, 18(11): 884-887.
7. 王人彥, 華永均, 郭志輝. 經(jīng)椎間孔入路單枚融合器結(jié)合椎弓根釘治療腰椎不穩(wěn). 中國骨傷, 2010, 23(4): 248-250.
8. 龍樹明, 吳術(shù)紅, 李啟運, 等. 經(jīng)椎間孔椎間融合椎弓根螺釘內(nèi)固定治療椎間盤源性腰痛. 中國脊柱脊髓雜志, 2007, 17(7): 538-542.
9. Banwart JC, Asher MA, Hassanein RS. Iliac crest bone graft harvest donor site morbidity: a statistical evaluation. Spine (Phila Pa 1976), 1995, 20(9): 1055-1060.
10. Majd ME, Vadhva M, Holt RT. Anterior cervical reconstruction using titanium cages with anterior plating. Spine (Phila Pa 1976), 1999, 24(15): 1604-1610.
11. Riew KD, Rhee JM. The use of titanium mesh cages in the cervical spine. Clin Orthop Relat Res, 2002, (394): 47-54.
12. Rousseau MA, Lazennec JY, Saillant G, et al. Circumferential arthrodesis using PEEK cages at the lumbar spine. J Spinal Disord Tech, 2007, 20(4): 278-281.
13. 朱琦, 趙隆隊, 付余良, 等. PEEK材料椎間融合器用于后路腰椎間融合的近期療效. 實用臨床醫(yī)學(xué), 2011, 12(7): 55-56.
14. Brantigan JW, Stefee AD. A carbon fiber implant to aid interbody lumbar fusion: two-year clinical results in the first 26 patients. Spine (Phila Pa 1976), 1993, 18(14): 2106-2117.
15. Stonecipher T, Wright S. Posterior lumbar interbody fusion with facet-screw fixation. Spine (Phila Pa 1976), 1989, 14(4): 468-471.
16. Jiya TU, Smit T, Royen BJ, et al. Posterior lumbar interbody fusion using non resorbable poly-ether-ether-ketone versus resorbable poly-L-lactide-co-D, L-lactide fusion devices. Clinical outcome at a minimum of 2-year follow-up. Eur Spine J, 2011, 20(4): 618-622.
17. Abdul QR, Qayum MS, Saradhi MV, et al. Clinico-radiological profile of indirect neural decompression using cage or auto graft as interbody construct in posterior lumbar interbody fusion in spondylolisthesis: Which is better? J Craniovertebral Junction Spine, 2011, 2(1): 12-16.
18. Yang X, Song Y, Liu L, et al. Anterior reconstruction with nano-hydroxyapatite/polyamide-66 cage after thoracic and lumbar corpectomy. Orthopedics, 2012, 35(1): e66-73.
19. Tomford WW. Transmission of disease through transplantation of musculoskeletal allografts. J Bone Joint Surg (Am), 1995, 77 (11): 1742-1754.
20. Wang X, Li Y, Wei J, et al. Development of biomimetic nano-hydroxyapatite/poly (hexamethylene adipamide) composites. Biomaterials, 2002, 23(24): 4787-4791.
21. 鄭謙, 周立偉, 魏世成, 等. 納米羥基磷灰石-聚酰胺人工骨修復(fù)犬下頜骨體缺損的實驗研究. 中華口腔醫(yī)學(xué)雜志, 2004, 39(1): 60-62.
22. 楊曦, 宋躍明, 劉浩, 等. 前路減壓n-HA/PA66支撐植骨內(nèi)固定治療胸腰椎爆裂骨折的近期臨床效果. 中國脊柱脊髓雜志, 2011, 21(11): 885-889.
23. 修鵬, 劉立岷, 宋躍明, 等. 納米羥基磷灰石/聚酰胺66椎體支撐體在脊髓型頸椎病前路手術(shù)重建中的應(yīng)用. 中國骨與關(guān)節(jié)外科, 2009, 2(5): 347-351.
24. 孫麟, 宋躍明, 劉浩, 等. 納米羥基磷灰石/聚酰胺66椎體支撐體在脊柱前柱手術(shù)重建中的應(yīng)用. 中國矯形外科雜志, 2011, 19(18): 1497-1500.
25. 孟純陽, 安洪, 蔣電明, 等. 網(wǎng)孔納米羥基磷灰石/聚酰胺人工骨修復(fù)兔橈骨缺損. 中華創(chuàng)傷雜志, 2005, 21(3): 187-191.
  1. 1. Harms JG, Jeszenszky D. The unilateral, transforaminal approach for posterior lumbar interbody fusion. Orthop Traumatol, 1998, 6: 88-99.
  2. 2. Rosenberg WS, Mummaneni PV. Transforaminal lumbar interbody fusion: technique, complications, and early results. Neurosurgery, 2001, 48(3): 569-574.
  3. 3. Lowe TG, Tahernia AD, O’Brien MF, et al. Unilateral transforaminal posterior lumbar interbody fusion (TLIF): indications, technique, and 2-year results. J Spinal Disord Tech, 2002, 415(1): 31-38.
  4. 4. Moskowitz A. Transforaminal lumbar interbody fusion. Orthop Clin North Am, 2002, 33(2): 359-366.
  5. 5. Chastain CA, Eck JC, Hodges SD, et al. Transforaminal lumbar interbody fusion: a retrospective study of long-term pain relief and fusion outcomes. Orthopedics, 2007, 30(5): 389-392.
  6. 6. 薛華明, 涂意輝, 蔡珉巍, 等. 單側(cè)TLIF聯(lián)合單側(cè)椎弓根釘內(nèi)固定治療腰椎退變疾患的臨床研究. 中國矯形外科雜志, 2010, 18(11): 884-887.
  7. 7. 王人彥, 華永均, 郭志輝. 經(jīng)椎間孔入路單枚融合器結(jié)合椎弓根釘治療腰椎不穩(wěn). 中國骨傷, 2010, 23(4): 248-250.
  8. 8. 龍樹明, 吳術(shù)紅, 李啟運, 等. 經(jīng)椎間孔椎間融合椎弓根螺釘內(nèi)固定治療椎間盤源性腰痛. 中國脊柱脊髓雜志, 2007, 17(7): 538-542.
  9. 9. Banwart JC, Asher MA, Hassanein RS. Iliac crest bone graft harvest donor site morbidity: a statistical evaluation. Spine (Phila Pa 1976), 1995, 20(9): 1055-1060.
  10. 10. Majd ME, Vadhva M, Holt RT. Anterior cervical reconstruction using titanium cages with anterior plating. Spine (Phila Pa 1976), 1999, 24(15): 1604-1610.
  11. 11. Riew KD, Rhee JM. The use of titanium mesh cages in the cervical spine. Clin Orthop Relat Res, 2002, (394): 47-54.
  12. 12. Rousseau MA, Lazennec JY, Saillant G, et al. Circumferential arthrodesis using PEEK cages at the lumbar spine. J Spinal Disord Tech, 2007, 20(4): 278-281.
  13. 13. 朱琦, 趙隆隊, 付余良, 等. PEEK材料椎間融合器用于后路腰椎間融合的近期療效. 實用臨床醫(yī)學(xué), 2011, 12(7): 55-56.
  14. 14. Brantigan JW, Stefee AD. A carbon fiber implant to aid interbody lumbar fusion: two-year clinical results in the first 26 patients. Spine (Phila Pa 1976), 1993, 18(14): 2106-2117.
  15. 15. Stonecipher T, Wright S. Posterior lumbar interbody fusion with facet-screw fixation. Spine (Phila Pa 1976), 1989, 14(4): 468-471.
  16. 16. Jiya TU, Smit T, Royen BJ, et al. Posterior lumbar interbody fusion using non resorbable poly-ether-ether-ketone versus resorbable poly-L-lactide-co-D, L-lactide fusion devices. Clinical outcome at a minimum of 2-year follow-up. Eur Spine J, 2011, 20(4): 618-622.
  17. 17. Abdul QR, Qayum MS, Saradhi MV, et al. Clinico-radiological profile of indirect neural decompression using cage or auto graft as interbody construct in posterior lumbar interbody fusion in spondylolisthesis: Which is better? J Craniovertebral Junction Spine, 2011, 2(1): 12-16.
  18. 18. Yang X, Song Y, Liu L, et al. Anterior reconstruction with nano-hydroxyapatite/polyamide-66 cage after thoracic and lumbar corpectomy. Orthopedics, 2012, 35(1): e66-73.
  19. 19. Tomford WW. Transmission of disease through transplantation of musculoskeletal allografts. J Bone Joint Surg (Am), 1995, 77 (11): 1742-1754.
  20. 20. Wang X, Li Y, Wei J, et al. Development of biomimetic nano-hydroxyapatite/poly (hexamethylene adipamide) composites. Biomaterials, 2002, 23(24): 4787-4791.
  21. 21. 鄭謙, 周立偉, 魏世成, 等. 納米羥基磷灰石-聚酰胺人工骨修復(fù)犬下頜骨體缺損的實驗研究. 中華口腔醫(yī)學(xué)雜志, 2004, 39(1): 60-62.
  22. 22. 楊曦, 宋躍明, 劉浩, 等. 前路減壓n-HA/PA66支撐植骨內(nèi)固定治療胸腰椎爆裂骨折的近期臨床效果. 中國脊柱脊髓雜志, 2011, 21(11): 885-889.
  23. 23. 修鵬, 劉立岷, 宋躍明, 等. 納米羥基磷灰石/聚酰胺66椎體支撐體在脊髓型頸椎病前路手術(shù)重建中的應(yīng)用. 中國骨與關(guān)節(jié)外科, 2009, 2(5): 347-351.
  24. 24. 孫麟, 宋躍明, 劉浩, 等. 納米羥基磷灰石/聚酰胺66椎體支撐體在脊柱前柱手術(shù)重建中的應(yīng)用. 中國矯形外科雜志, 2011, 19(18): 1497-1500.
  25. 25. 孟純陽, 安洪, 蔣電明, 等. 網(wǎng)孔納米羥基磷灰石/聚酰胺人工骨修復(fù)兔橈骨缺損. 中華創(chuàng)傷雜志, 2005, 21(3): 187-191.