納米羥基磷灰石/聚酰胺66復(fù)合人工椎板在下腰椎手術(shù)中的臨床應(yīng)用

趙亮+何斌斌+陳肖+溫清波+陳浩雄+彭力平

[摘要] 目的 探討人工椎板[納米羥基磷灰石/聚酰胺66（n-HA/PA66）]在預(yù)防椎管內(nèi)瘢痕粘連及脊柱后柱結(jié)構(gòu)重建中的作用。 方法 2008年1月～2012年5月本院采用n-HA/PA66復(fù)合生物活性人工椎板治療椎板切除術(shù)后椎板缺損患者37例，均使用1個人工椎板，觀察治療效果。 結(jié)果 術(shù)后均無傷口感染，傷口Ⅰ期愈合。37例均獲5～20個月隨訪。術(shù)后腦脊液漏1例，經(jīng)妥善處理后愈合。1例中央型椎間盤突出患者因術(shù)中過度牽拉造成術(shù)后神經(jīng)根損害癥狀加重，經(jīng)神經(jīng)營養(yǎng)用藥及理療6個月后神經(jīng)功能基本恢復(fù)。其余患者術(shù)后腰腿痛癥狀明顯改善，術(shù)后復(fù)查無加重，腰椎活動度良好。術(shù)區(qū)無明顯排斥反應(yīng)。37例術(shù)后CT檢查示椎管擴(kuò)大；X線、CT及三維重建示術(shù)后4～6個月人工椎板與受體骨接觸界面模糊，間隙消失。3例CT示人工椎板于椎板邊緣部分分離，查體患者無不適癥狀。 結(jié)論 新型n-HA/PA66復(fù)合生物活性人工椎板，可有效防止外源性瘢痕壓迫神經(jīng)根及硬膜囊，有效恢復(fù)椎管結(jié)構(gòu)，術(shù)后對腰椎活動無明顯影響。

[關(guān)鍵詞] 人工椎板（納米羥基磷灰石/聚酰胺66）；椎板切除術(shù)；粘連；重建；功能

[中圖分類號] R318.1[文獻(xiàn)標(biāo)識碼] B[文章編號] 1674-4721（2014）05（c）-0159-04

Clinical application of the artificial vertebral lamina (nano-hydroxyapatite/polyamide 66) in surgical treatment of the lower lumbar spine

ZHAO Liang HE Bin-bin CHEN Xiao WEN Qing-bo CHEN Hao-xiong PENG Li-ping

Department of Orthopedics and Traumatology,the Second Hospital of Traditional Chinese Medicine of Shenzhen City,Shenzhen 518034,China

[Abstract] Objective To investigate the role of artificial vertebral lamina [nano-hydroxyapatite/polyamide 66 (n-HA/PA66)] in the prevention of the scar adhesions in lumbar spinal canal and the reconstruction of posterior vertebral laminae structure. Methods 37 cases of patients with lamina defect after laminectomy in our hospital from January 2008 to May 2012 were treated with n-HA/PA66 composite bioactive artificial vertebral lamina,each person with an artificial vertebral lamina.Then the clinical efficacy was observed. Results There was no postoperative wound infection,and wound reached phase Ⅰ healing.All of 37 cases were followed up for 5-20 months.Postoperative cerebrospinal fluid leakage only occurred in one case,and healed after suitable treatment.One case with central lumbar disc herniation suffered worse postoperative radiculopathy symptoms for excessive drag,and neural function got basic recovery after nerve neurotrophic drugs and physical therapy for 6 months.Low back pain symptoms in the remaining patients were obviously improved after operation with no aggravation,and lumbar had good activity.No obvious rejection was seen in operation area.postoperative CT showed the spinal canal in 37 cases enlarged;X-ray, CT and 3D reconstruction indicated interface between artificial vertebral lamina and the recipient bone was fuzzy after 4-6 months,and the gap disappeared.CT showed isolation of artificial vertebral lamina and penumbra of vertebral lamina occurred in 3 cases,while,patients were no discomfortable symptoms through medical examination. Conclusion The new n-HA/PA66 composite bioactive artificial vertebral lamina can effectively prevent the exogenous scar compression of nerve root and spinal dural sac,significantly recover vertebral canal structure,and had no significant effect on lumbar activity after operation.

[Key words] Artificial vertebral lamina (nano-hydroxyapatite/pelyamide66);Laminectomy;Adhesion;Reconstruction;Function

嚴(yán)重的椎管狹窄癥及巨大的間盤突出癥首選的治療方法仍是椎板切除減壓，髓核摘除術(shù)，臨床療效顯著。但椎板切除減壓破壞了脊柱的穩(wěn)定性，同時瘢痕組織的壓迫又造成了新的醫(yī)源性壓迫，使部分患者出現(xiàn)新的腰腿痛癥狀，甚至疼痛癥狀加重導(dǎo)致手術(shù)失敗[1-2]。近年來國內(nèi)外學(xué)者采用了很多材料和方法，但結(jié)果仍不太理想[3]。如何防止椎板切除術(shù)后硬膜周圍瘢痕形成、減少粘連以及最大限度地保持脊柱的穩(wěn)定性是迫切需要解決的難題。近年來多主張行椎板成形術(shù)預(yù)防硬膜外粘連及重建脊柱的后路穩(wěn)定性[4]。2008年1月～20012年5月本院對37例患者在脊柱手術(shù)中使用了人工椎板[納米羥基磷石/聚酰胺66（nano-hydroxyapatite/polyamide 66，n-HA/PA66），以預(yù)防術(shù)后瘢痕粘連，重建脊柱結(jié)構(gòu)，療效滿意。

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