Li Qiujiang, Xiu Peng, Yang Xi, Wang Lei, Liu Limin, Song Yueming
Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, China.
Front Bioeng Biotechnol. 2024 May 10;12:1376596. doi: 10.3389/fbioe.2024.1376596. eCollection 2024.
Previous studies have confirmed the advantages and disadvantages of autogenous iliac bone and nano-hydroxyapatite/polyamide 66 (n-HA/PA66) cage. However, there is no conclusive comparison between the efficacy of the two implant materials in spinal tuberculosis bone graft fusion. The aim of this study was to analyze the mid-to long-term clinical and radiologic outcomes between n-HA/PA66 cage and autogenous iliac bone for anterior reconstruction application of spinal defect for thoracolumbar tuberculosis.
We retrospectively reviewed all patients who underwent anterior debridement and strut graft with n-HA/PA66 cage or iliac bone combined with anterior instrumentations between June 2009 and June 2014. One-to-one nearest-neighbor propensity score matching (PSM) was used to match patients who underwent n-HA/PA66 cage to those who underwent iliac bone. Clinical outcomes were assessed using the Japanese Orthopaedic Association (JOA) and visual analogue score (VAS). Radiographic evaluations included cage subsidence and segmental angle.
At the end of the PSM analysis, 16 patients from n-HA/PA66 cage group were matched to 16 patients in Iliac bone group. The C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) values in the n-HA/PA66 group decreased significantly from 33.19 ± 10.89 and 46.63 ± 15.65 preoperatively, to 6.56 ± 2.48 and 9.31 ± 3.34 at the final follow-up, respectively ( < 0.001). There were no significant differences in the CRP and ESR values between the two groups at the final follow-up. The VAS and JOA scores in the iliac bone and n-HA/PA66 group were significantly improved at the 3-month follow-up postoperatively (both < 0.001). Then, improvements of VAS and JOA scores continue long at final follow-up. However, there were no significant differences in the VAS and JOA scores at any time point between the two groups ( > 0.05). Although the segmental angle (SA) significantly increased after surgery in both groups, there was no significant difference at any time point after surgery ( > 0.05). There were no significant differences in the cage subsidence and fusion time between the two groups.
Overall, our data suggest that the n-HA/PA66 cage outcomes are comparable to those in the autogenous iliac bone, with a similar high fusion rate as autogenous iliac bone.
既往研究已证实自体髂骨和纳米羟基磷灰石/聚酰胺66（n-HA/PA66）椎间融合器的优缺点。然而，在脊柱结核骨移植融合中，这两种植入材料的疗效尚无定论。本研究旨在分析n-HA/PA66椎间融合器与自体髂骨在胸腰椎结核脊柱缺损前路重建中的中长期临床和影像学结果。
我们回顾性分析了2009年6月至2014年6月期间所有接受n-HA/PA66椎间融合器或髂骨前路清创及支撑植骨并联合前路内固定的患者。采用一对一最近邻倾向评分匹配（PSM）方法，将接受n-HA/PA66椎间融合器治疗的患者与接受髂骨治疗的患者进行匹配。使用日本骨科协会（JOA）评分和视觉模拟评分（VAS）评估临床结果。影像学评估包括椎间融合器下沉和节段角度。
PSM分析结束时，n-HA/PA66椎间融合器组的16例患者与髂骨组的16例患者匹配。n-HA/PA66组的C反应蛋白（CRP）和红细胞沉降率（ESR）值分别从术前的33.19±10.89和46.63±15.65显著下降至末次随访时的6.56±2.48和9.31±3.34（<0.001）。末次随访时两组间CRP和ESR值无显著差异。术后3个月随访时，髂骨组和n-HA/PA66组的VAS和JOA评分均显著改善（均<0.001）。然后，在末次随访时VAS和JOA评分持续改善。然而，两组在任何时间点的VAS和JOA评分均无显著差异（>0.05）。虽然两组术后节段角度（SA）均显著增加，但术后任何时间点均无显著差异（>0.05）。两组间椎间融合器下沉和融合时间无显著差异。
总体而言，我们的数据表明，n-HA/PA66椎间融合器的结果与自体髂骨相当，融合率与自体髂骨相似。
