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目的探讨纳米羟基磷灰石/聚酰胺66(nano-hydroxyapatite/polyamide 66,n-HA/PA66)支撑体在脊柱肿瘤切除后脊柱稳定性重建中的安全性及临床疗效。方法 2008年1月-2009年12月,对11例脊柱肿瘤行前路或前后联合入路肿瘤切除、n-HA/PA66支撑体椎间植入重建脊柱稳定性。男6例,女5例;年龄16～61岁,平均44.5岁。病程2～14个月,平均6.8个月。其中转移癌5例,骨巨细胞瘤2例,骨母细胞型骨肉瘤1例,软骨肉瘤1例,非霍奇金淋巴瘤2例。病变位于颈椎2例,胸椎6例,腰椎3例。术前Frankel神经功能分级为A级1例,B级3例,C级2例,D级2例,E级3例。结果手术切口均Ⅰ期愈合,未见严重术中及术后并发症。3例肝癌转移及1例肺癌转移患者于术后5～9个月因原发疾病死亡;余7例术后随访时间10～18个月,平均14.4个月。术后3个月Frankel神经功能分级较术前不同程度改善。X线片及三维CT示n-HA/PA66支撑体无明显塌陷、下沉、断裂及移位,内固定物位置良好。术后6个月存活的10例患者植骨均达骨性融合。术前病椎邻近上、下椎间高度为(97.5±15.4)mm,术后3个月和末次随访时分别为(110.5±16.1)mm和(109.4±16.2)mm,与术前比较差异均有统计学意义(P<0.05);术后3个月与末次随访比较,差异无统计学意义(P>0.05)。2例前路经胸手术患者术后出现双侧胸腔积液,予以穿刺抽液及胸腔闭式引流术后痊愈。随访期间1例L3椎体骨巨细胞瘤术后7个月原位复发,1例T11椎体软骨肉瘤患者术后14个月在L3椎体复发,均再次行肿瘤切除、n-HA/PA66支撑体植入重建术,术后随访无复发,原手术部位达骨性融合。结论 n-HA/PA66支撑体具有良好的安全性和椎间支撑稳定作用,植骨融合满意,是一种较理想的新型脊柱前路重建方法。
Objective To investigate the nano-hydroxyapatite / polyamide 66 (nano-hydroxyapatite / polyamide 66, n-HA / PA66) support the safety and clinical efficacy in the reconstruction of spinal stability after spinal tumor removal. METHODS: From January 2008 to December 2009, 11 patients with spinal tumors underwent resection of the anterior or anterior and posterior approach, and spinal stabilization was reconstructed with intervertebral implantation of n-HA / PA66 support. 6 males and 5 females; aged 16 to 61 years old, average 44.5 years old. Course of 2 to 14 months, an average of 6.8 months. Among them, 5 were metastatic carcinoma, 2 giant cell tumor of bone, 1 osteosarcoma osteosarcoma, 1 chondrosarcoma and 2 non-Hodgkin’s lymphoma. Lesions in 2 cases of cervical, thoracic 6 cases, 3 cases of lumbar. Preoperative Frankel neurological grading was Grade A in 1 case, Grade B in 3, Grade C in 2, Grade D in 2, and Grade E in 3. The results of surgical incision healed, no serious intraoperative and postoperative complications. 3 cases of liver cancer metastasis and 1 case of lung cancer metastasis died of primary disease 5 to 9 months after operation. The remaining 7 cases were followed up for 10 to 18 months (average 14.4 months). At 3 months after operation, Frankel neurological function improved to some extent compared with that before operation. X-ray film and three-dimensional CT showed n-HA / PA66 support without significant collapse, sinking, fracture and displacement, internal fixtures in good position. Ten patients survived six months after operation, and all the bone grafts reached their bony fusion. The intervertebral height of the preoperative vertebra adjacent to the upper and lower vertebrae was (97.5 ± 15.4) mm, and the mean preoperative intervertebral height was (110.5 ± 16.1) mm and (109.4 ± 16.2) mm at the third month and the last follow-up, respectively (P <0.05). There was no significant difference between the last follow-up and the third month after operation (P> 0.05). 2 cases of anterior trans-thoracic surgery patients with bilateral pleural effusion, to puncture fluid and thoracic closure drainage after healed. During the follow-up period, one case of L3 giant cell tumor of the vertebrae recurred in situ at 7 months after operation. One case of T11 vertebral chondrosarcoma recurred in L3 vertebral body at 14 months after operation. Tumor resection was performed again. The n-HA / PA66 Support implant reconstruction surgery, follow-up no recurrence, the original surgical site up to bone fusion. Conclusion n-HA / PA66 support has good safety and stability of intervertebral bracing, satisfactory fusion of bone graft and bone graft, which is an ideal new anterior approach to anterior spinal reconstruction.