[1]柴旭斌,周英杰,郑怀亮,等.纳米羟基磷灰石/聚酰胺66人工骨块在颈椎后路双开门椎管成形术中的应用[J].中医正骨,2016,28(08):32-34.
点击复制

纳米羟基磷灰石/聚酰胺66人工骨块在颈椎后路双开门椎管成形术中的应用()
分享到:

《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第28卷
期数:
2016年08期
页码:
32-34
栏目:
临床报道
出版日期:
2016-08-20

文章信息/Info

作者:
柴旭斌周英杰郑怀亮赵刚赵鹏飞王少纯
河南省洛阳正骨医院/河南省骨科医院,河南 洛阳 471002
关键词:
颈椎病 椎管狭窄 后纵韧带骨化 颈椎后路双开门椎管扩大成形术 纳米羟基磷灰石/聚酰胺66 人工骨
摘要:
目的:探讨应用纳米羟基磷灰石/聚酰胺66人工骨块行颈椎后路双开门椎管扩大成形术的临床疗效和安全性。方法:2011年1月至2013年12月收治颈部疾病患者32例。男23例,女9例; 年龄32~78岁,中位数56岁; 脊髓型颈椎病11例,发育性颈椎管狭窄症7例,颈椎后纵韧带钙化症14例; 病程5~15个月,中位数10个月。均采用颈椎后路双开门椎管扩大成形术治疗,以纳米羟基磷灰石/聚酰胺66人工骨块作为间隔物。采用日本骨科学会(Japanese orthopaedic association,JOA)制定的脊髓型颈椎病评分标准(17分法)评定脊髓功能; 进行颈椎X线、CT、MRI检查,观察颈椎曲度和活动度、植骨块位置和愈合情况,测定椎管矢状径; 观察记录治疗及随访期间的并发症发生情况。结果:所有患者均行C3~C6后路双开门椎管扩大成形术,手术时间(1.6±0.3)h,术中出血量(188±50)mL。所有患者均获12个月以上随访,切口均甲级愈合,未出现过敏或毒性反应,均未出现脊髓损伤加重表现。术后所有患者的症状均明显缓解,3例患者出现单侧或双上肢烧灼样疼痛,治疗1~3个月后消失; 术前、术后1周、术后3个月、术后12个月的JOA评分分别为(6.56±2.52)分、(10.82±1.47)分、(11.94±1.63)分、(12.35±1.96)分。影像学检查显示术后颈椎椎管容积明显增加、颈脊髓漂移满意、脊髓压迹消失; 术前最狭窄部椎管矢状径(8.86±3.69)mm,出院时增加至(14.27±2.54)mm; 植骨块位置维持良好,所有植骨块均与棘突融合; 未发生再关门、颈椎后凸畸形及颈椎节段性不稳等并发症。结论:应用纳米羟基磷灰石/聚酰胺66人工骨块行颈椎后路双开门椎管扩大成形术,可有效扩大并维持颈椎管容积,促进脊髓功能恢复,且植骨愈合良好,并发症少,值得临床推广应用。

参考文献/References:

[1] Seichi A,Chikuda H,Kimura A,et al.Intraoperative ultrasonographic evaluation of posterior decompression via laminoplasty in patients with cervical ossification of the posterior longitudinal ligament:correlation with 2-year follow-up results[J].J Neurosurg Spine,2010,13(1):47-51. [2] Kaneyama S,Sumi M,Kanatani T,et al.Prospective study and multivariate analysis of the incidence of C5 palsy after cervical laminoplasty[J].Spine(Phila Pa 1976),2010,35(26):E1553-E1558. [3] Kimura A,Seichi A,Inoue H,et al.Long-term results of double-door laminoplasty using hydroxyapatite spacers in patients with compressive cervical myelopathy[J].Eur Spine J,2011,20(9):1560-1566. [4] Seichi A,Hoshino Y,Kimura A,et al.Neurological complications of cervical laminoplasty for patients with ossification of the posterior longitudinal ligament-a multi-institutional retrospective study[J].Spine(Phila Pa 1976),2011,36(15):E998-1003. [5] Hirabayashi S,Yamada H,Motosuneya T,et al.Comparison of enlargement of the spinal canal after cervical laminoplasty:open-door type and double-door type[J].Eur Spine J,2010,19(10):1690-1694. [6] Takahashi H,Yokoyama Y,Terajima F,et al.Isolated neck extensor myopathy causing a dropped head:a case report[J].J Orthop Surg(Hong Kong),2011,19(1):104-107. [7] Kim K,Isu T,Sugawara A,et al.Detailed study of graft sinking and worsening of the fused segment angle in patients with cervical disease treated with the Williams-Isu method[J].Neurol Med Chir(Tokyo),2011,51(3):208-213. [8] Kim K,Isu T,Sugawara A,et al.Treatment of cervical OPLL by cervical anterior fusion using autologous vertebral bone grafts[J].Acta Neurochir(Wien),2009,151(11):1549-1555. [9] Goldschlager T,Ghosh P,Zannettino A,et al.A comparison of mesenchymal precursor cells and amnion epithelial cells for enhancing cervical interbody fusion in an ovine model[J].Neurosurgery,2011,68(4):1025-1034. [10] Goldschlager T,Rosenfeld JV,Ghosh P,et al.Cervical interbody fusion is enhanced by allogeneic mesenchymal precursor cells in an ovine model[J].Spine(Phila Pa 1976),2011,36(8):615-623. [11] Lim MC,Kim JY,Kim TH,et al.Allogeneic blood transfusion given before radiotherapy is associated with the poor clinical outcome in patients with cervical cancer[J].Yonsei Med J,2008,49(6):993-1003. [12] 蒋协远,王大伟.骨科临床疗效评价标准[M].北京:人民卫生出版社,2005:104. [13] 陈爽,杨勇,梅伟,等.颈后路有限化双开门椎管扩大纳米仿生骨棘突间植入术治疗多节段脊髓型颈椎病[J].中医正骨,2014,26(10):49-51. [14] Wang X,Li Y,Wei J,et al.Development of biomimetic nano-hydroxyapatite/poly(hexamethylene adipamide)composites[J].Biomaterials,2002,23(24):4787-4791. [15] Azami M,Samadikuchaksaraei A,Poursamar SA.Synthesis and characterization of a laminated hydroxyapatite/gelatin nanocomposite scaffold with controlled pore structure for bone tissue engineering[J].Int J Artif Organs,2010,33(2):86-95.

相似文献/References:

[1]孙献武,于香兰,邵海燕,等.应用三维动静态平衡康复模式治疗 非脊髓型颈椎病的临床研究[J].中医正骨,2015,27(11):8.
 SUN Xianwu,YU Xianglan,SHAO Haiyan,et al.Clinical study on three-dimensional dynamic and static equilibrium rehabilitation modality in the treatment of non-myelopathy type cervical spondylosis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(08):8.
[2]江建春.神经根型颈椎病的中医药治疗研究概况[J].中医正骨,2015,27(11):71.
[3]吴青坡,孙国绍,王林杰.后路椎管减压联合腰椎椎弓根钉动态稳定装置内固定 治疗单节段腰椎退行性疾病[J].中医正骨,2015,27(10):42.
[4]韦英成,董彤,吴肖梅,等.推拿手法治疗神经根型颈椎病的研究进展[J].中医正骨,2015,27(10):65.
[5]张莉,秦丹霞,张细姣.Orem自理理论在前路手术治疗脊髓型颈椎病 围手术期护理中的应用[J].中医正骨,2015,27(09):75.
[6]李林军.应用膨胀式椎弓根螺钉内固定治疗合并骨质疏松的 胸腰椎退行性疾病[J].中医正骨,2015,27(08):49.
[7]邸保林,董国顺,林红猛.俯卧斜扳法治疗神经根型颈椎病[J].中医正骨,2015,27(07):70.
[8]邵礼晖,潘浩.Coflex棘突间动态稳定系统治疗腰椎退变性疾病40例[J].中医正骨,2015,27(02):37.
[9]陈冠军,陈扬,庄汝杰.可灌注骨水泥椎弓根螺钉系统 在老年腰椎疾患手术中的应用[J].中医正骨,2015,27(02):40.
[10]白玉,王爱国.郭春园教授治疗颈椎病的学术思想探究[J].中医正骨,2015,27(02):64.
[11]郭润栋,张爱丽.微型钛板在颈椎后路单开门椎管扩大成形术中的应用[J].中医正骨,2017,29(01):67.

备注/Memo

备注/Memo:
基金项目:河南省重点中医学科学术带头人基金培养项目(2100601) 通讯作者:周英杰 E-mail:1099168230@qq.com
更新日期/Last Update: 1900-01-01