赵亮+何斌斌+陈肖+温清波+陈浩雄+彭力平

[摘要] 目的 探讨人工椎板[纳米羟基磷灰石/聚酰胺66（n-HA/PA66）]在预防椎管内瘢痕粘连及脊柱后柱结构重建中的作用。 方法 2008年1月～2012年5月本院采用n-HA/PA66复合生物活性人工椎板治疗椎板切除术后椎板缺损患者37例，均使用1个人工椎板，观察治疗效果。 结果 术后均无伤口感染，伤口Ⅰ期愈合。37例均获5～20个月随访。术后脑脊液漏1例，经妥善处理后愈合。1例中央型椎间盘突出患者因术中过度牵拉造成术后神经根损害症状加重，经神经营养用药及理疗6个月后神经功能基本恢复。其余患者术后腰腿痛症状明显改善，术后复查无加重，腰椎活动度良好。术区无明显排斥反应。37例术后CT检查示椎管扩大；X线、CT及三维重建示术后4～6个月人工椎板与受体骨接触界面模糊，间隙消失。3例CT示人工椎板于椎板边缘部分分离，查体患者无不适症状。 结论 新型n-HA/PA66复合生物活性人工椎板，可有效防止外源性瘢痕压迫神经根及硬膜囊，有效恢复椎管结构，术后对腰椎活动无明显影响。

[关键词] 人工椎板（纳米羟基磷灰石/聚酰胺66）；椎板切除术；粘连；重建；功能

[中图分类号] R318.1[文献标识码] B[文章编号] 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

严重的椎管狭窄症及巨大的间盘突出症首选的治疗方法仍是椎板切除减压，髓核摘除术，临床疗效显著。但椎板切除减压破坏了脊柱的稳定性，同时瘢痕组织的压迫又造成了新的医源性压迫，使部分患者出现新的腰腿痛症状，甚至疼痛症状加重导致手术失败[1-2]。……