n-HA/PA66与PEEK cage在颈前路椎间盘切除减压术后椎间隙重建的比较研究

中国临床解剖学杂志 ›› 2012, Vol. 30 ›› Issue (6): 687-692.

n-HA/PA66与PEEK cage在颈前路椎间盘切除减压术后椎间隙重建的比较研究

刘显宏，　欧云生，　蒋电明，　权正学，　张乐，　陈鑫，　胡侦明

重庆医科大学附属第一医院骨科，重庆 400016

收稿日期:2012-05-02 出版日期:2012-11-25 发布日期:2012-12-11
通讯作者: 欧云生，博士，副教授，硕士生导师，E-mail:ouyunsheng　2001@yahoo.com.cn E-mail:lewhyunhom@163.com
作者简介:刘显宏（1986-），男，硕士，研究方向：脊柱退行性变
基金资助:
国家高新技术研究发展（“863”）（2002AA326020）；重庆市科学技术委员会科技攻关项目（cstc2012gg-yyjs10018）

Initial curative effect comparision of ano-hydroxyapatite polyamide-66 cage and polyetheretherketone cage on anterior cervical intervertebral disc discectomy and fusion

LIU Xian-hong, OU Yun-sheng, JIANG Dian-ming, QUAN Zheng-xue, ZHANG Le, CHEN-Xin, HU Zhen-ming

Department of Orthopaedics, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China

Received:2012-05-02 Online:2012-11-25 Published:2012-12-11

摘要/Abstract

摘要：

目的　观察比较纳米羟基磷灰石/聚酰胺66颈椎融合器（n-HA/PA66 Cage）与聚醚醚酮颈椎融合器(PEEK Cage)在颈前椎间盘切除减压术后椎间隙植骨重建的初期疗效。方法　回顾性分析2008年6月~2011年6月手术治疗资料完整的57例颈椎病患者，行颈前路椎间盘切除减压Cage植骨融合钛钉板系统内固定治疗，其中31例采用n-HA/PA66 cage, 26例采用PEEK cage 。术后随访包括影像学及临床疗效评价，影像学评价包括术前、术后正侧位片、动力位片观察植骨融合率、塌陷率、颈椎曲度及手术节段椎间隙高度情况；临床疗效采用Odom标准评定。结果　n-HA/PA66组患者6月时获得97.7%植骨融合，PEEK组融合率100%，两组融合率无统计学差异（P＞0.05）；n-HA/PA66组术后颈椎丢失的角度为(2.06±1.77)°较PEEK组(2.39±1.56)°稍低，两组数据无统计学差异（P=0.384）；n-HA/PA66组与　PEEK组术后平均椎间隙丢失高度无统计学意义（0.46±0.52 mm，0.41±0.18 mm，P=0.599），其中n-HA/PA66组出现1例患者1个节段塌陷，塌陷率2.3%，与PEEK组塌陷率（0%）比较无统计学差异（P=0.372）；PEEK组获得81%临床优良率对比n-HA/PA66组77%的优良率无统计学差异（P=0.757）。结论　颈前路椎间盘切除减压后，n-HA/PA66与PEEK cage椎间隙植骨融合并内固定治疗颈椎病的初期临床疗效与影像学结果均较好且相似。

关键词: , 纳米羟基磷灰石, 聚醚醚酮, 椎间融合器, 颈椎前路融合术

Abstract:

Objective　To evaluate the preliminary efficacy using polyetheretherketone cage (PEEK Cage) and Nano-hydroxyapatite polyamide/66 cage (n-HA/PA66 Cage) composites for reconstruction following anterior cervical intervertebral discectomy and fusion (ACDF) in cervical spondylosis.　Methods　We performed a retrospective study of patients (57 cases, 31cases in n-HA/PA66 group, 26 cases in PEEK group) with cervical spondylopathy who underwent ACDF by two different cages between June 2008 and June 2011. Cervical pathologies included cervial spondylotic myelopathy and cervical radiculopathy. All patients were assessed clinically and radiologically. Clinical outcome was evaluated using Odom's criteria, radiology result included subsidence of the cages, the angle of cervical lordosis, the fusion rate and interspace height.　Results　There was no significant difference of fusion rate between both groups （97.7% vs. 100% , P＞0.05 ）. As well the loss of cervical lordosis (2.06±1.77° vs. 2.39±1.56°, P=0.384). The mean loss of interspace height (0.46±0.52 mm) in n-HA/PA66 group was a little higher than that (0.41±0.18 mm) in PEEK group, without significant difference in both groups（P=0.599）. An interspace collapse of 3mm or greater was observed in 2.3% in n-HA/PA 66 cage group, compared with zero one in the PEEK group(P=0.372). The PEEK group achieved an 81% rate of successful clinical outcomes, compared with 77% in the n-HA/PA 66 group (P=0.757).　Conclusions　The n-HA/PA66 cage is as good as PEEK cage in preliminary outcomes for anterior cervical intervertebral disc discectomy and fusion.

Key words: Nano-hydroxyapatite polyamide/66(n-HA/PA 66), Polyetheretherketone (PEEK ), Cage, Anterior cervical intervertebral discectomy and fusion (ACDF)

中图分类号:

R681.53

刘显宏, 欧云生, 蒋电明, 权正学, 张乐, 陈鑫, 胡侦明. n-HA/PA66与PEEK cage在颈前路椎间盘切除减压术后椎间隙重建的比较研究[J]. 中国临床解剖学杂志, 2012, 30(6): 687-692.

LIU Xian-Hong, OU Yun-Sheng, JIANG Dian-Meng, QUAN Zheng-Hua, ZHANG Le, CHEN Xin, HU Zhen-Meng. Initial curative effect comparision of ano-hydroxyapatite polyamide-66 cage and polyetheretherketone cage on anterior cervical intervertebral disc discectomy and fusion[J]. Chinese Journal Of Clinical Anatomy, 2012, 30(6): 687-692.

参考文献

[1]欧云生, 蒋电明, 权正学, 等. n-HA/PA66复合生物活性融合器在颈椎病前路减压融合术中的初步应用研究
[J]. 生物医学工程学杂志, 2010, 27(2):324-327.

[2] 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.

[3] Vaccaro AR, Carrino JA, Venger BH, et al. Use of a bioabsorbable anterior cervical plate in the treatment of cervical degenerative and traumatic disc disruption
[J]. J Neurosurg, 2002, 97(4 Suppl):473-480.

[4] Kao FC, Niu CC, Chen LH, et al. Maintenance of interbody space in one- and two-level anterior cervical interbody fusion: comparison of the effectiveness of autograft, allograft, and cage
[J]. Clin Orthop Relat Res, 2005,(430):108-116.

[5] Young WF, Rosenwasser RH. An early comparative analysis of the use of fibular allograft versus autologous iliac crest graft for interbody fusion after anterior cervical discectomy
[J]. Spine, 1993,18(9):1123-1124.

[6] Hauerberg J, Kosteljanetz M, Boge-Rasmussen T, et al. Anterior cervical discectomy with or without fusion with ray titanium cage: a prospective randomized clinical study
[J]. Spine, 2008, 33(5):458-464.

[7] Niu CC, Liao JC, Chen WJ, et al. Outcomes of interbody fusion cages used in 1 and 2-levels anterior cervical discectomy and fusion: titanium cages versus polyetheretherketone (PEEK) cages
[J]. J Spinal Disord Tech, 2010, 23(5):310-316.

[8] Marotta N, Landi A, Tarantino R, et al. Five-year outcome of stand-alone fusion using carbon cages in cervical disc arthrosis
[J]. Eur Spine J, 2011, 20(Suppl 1):S8-12.

[9] Bartels RH, Donk RD, Feuth T. Subsidence of stand-alone cervical carbon fiber cages
[J]. Neurosurgery, 2006, 58(3):502-508.

[10]Ou Y, Jiang D, Quan Z, et al. Application of artificial vertebral body of biomimetic nano-hydroxyapatite/polyamide 66 composite in anterior surgical treatment of thoracolumbar fractures
[J]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2007, 21(10):1084-1088.

[11]汪雷, 宋跃明, 裴福兴, 等. 纳米羟基磷灰石/聚酰胺66支撑体重建肿瘤切除术后脊柱稳定性的初步应用
[J]. 中国修复重建外科杂志, 2011, 25(8):941-945.

[12] 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.

[13]宋跃明, 陈日高, 刘立岷, 等. 多孔纳米羟基磷灰石/聚酰胺66椎间融合器治疗胸腰椎爆裂骨折的早期临床研究
[J]. 中华骨科杂志, 2010, 30(4):336-340.

[14] 李玉宝, 魏杰. 纳米生物医用材料及其应用
[J]. 中国医学科学院学报, 2002, 24(2):203-206.

[15] 孟纯阳, 安洪, 蒋电明, 等. 新型纳米骨重建和修复材料羟基磷灰石/聚酰胺体内植入的生物相容性及安全性
[J]. 中国临床康复, 2004, 8(29):6330-6333.

[16] Hee HT, Majd ME, Holt RT, et al. Complications of multilevel cervical corpectomies and reconstruction with titanium cages and anterior plating
[J]. J Spinal Disord Tech, 2003, 16(1):1-8.

[17]Thalgott JS, Xiongsheng C, Giuffre JM. Single stage anterior cervical reconstruction with titanium mesh cages, local bone graft, and anterior plating
[J]. Spine J, 2003,3(4):294-300.

[18]Schmieder K, Wolzik-Grossmann M, Pechlivanis I, et al. Subsidence of the wing titanium cage after anterior cervical interbody fusion: 2-year follow-up study
[J]. J Neurosurg Spine, 2006, 4(6):447-453.

[19] Gercek E, Arlet V, Delisle J, et al. Subsidence of stand-alone cervical cages in anterior interbody fusion: warning
[J]. Eur Spine J, 2003,12(5):513-516.

[20] Liao JC, Niu CC, Chen WJ, et al. Polyetheretherketone (PEEK) cage filled with cancellous allograft in anterior cervical discectomy and fusion
[J]. Int Orthop, 2008, 32(5):643-648.