Comparison of nano-hydroxyapatite/polyamide 66 bioactive support and autologous iliac bone in bone grafting and fusion for elderly patients with lumbar tuberculosis_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YE Jiekai ¹ ,  FEI Jun ² , LAI Zhen ² , ZHANG Peng ² , HU Jinping ² , HU Shengping ² , ZHANG Chenwei ²

1. The Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou Zhejiang, 310053, P. R. China;
2. Department of Orthopedics, Hangzhou Chest Hospital Affiliated to Zhejiang University Medical College, Hangzhou Zhejiang, 310003, P. R. China;

Corresponding?author：

FEI Jun, Email: jamfee67@163.com

Keywords：

Nano-hydroxyapatite/polyamide 66; bone grafting and fusion; lumbar spinal tuberculosis; the elderly

DOI：

10.7507/1002-1892.202110088

Video：

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Objective To investigate the safety of nano-hydroxyapatite/polyamide 66 (n-HA/PA66) bioactive support in bone grafting and fusion for elderly patients with lumbar tuberculosis, and to analyze its effectiveness and advantages by comparing with autologous iliac bone grafting. Methods A retrospective analysis was performed on 48 elderly patients with lumbar tuberculosis who met the selection criteria between January 2017 and January 2020. The patients all underwent one-stage posterior pedicle screw internal fixation combined with anterior lesion removal and bone grafting and fusion, of which 23 cases applied n-HA/PA66 bioactive support+allogeneic bone graft (n-HA/PA66 group) and 25 cases applied autologous iliac bone graft (autologous iliac bone group). There was no significant difference between the two groups in gender, age, bone density, disease duration, lesion segment, and preoperative pain visual analogue scale (VAS) score, Japanese Orthopaedic Association (JOA) score, and Cobb angle (P>0.05). The operation time, intraoperative blood loss, and postoperative complications, as well as the VAS score, JOA score, American Spinal Injury Association (ASIA) spinal cord injury grading, Cobb angle, and bone fusion were recorded and compared between the two groups. Results The operations were completed successfully in both groups. n-HA/PA66 group had significantly less operation time and intraoperative blood loss than the autologous iliac bone group (P<0.05). All patients were followed up 12-24 months, with an average of 15.7 months. And the difference in follow-up time between the two groups was not significant (P>0.05). Postoperative complications occurred in 3 cases (13%) in the n-HA/PA66 group and 10 cases (40%) in the autologous iliac group, and the difference in the incidence of complications between the two groups was significant (χ²=4.408, P=0.036). The postoperative VAS scores and JOA scores significantly improved when compared with the preoperative scores in both groups (P<0.05), and the difference was significant (P<0.05) between 2 weeks after operation and the last follow-up. The difference in VAS score at 2 weeks after operation was significant between the two groups (P<0.05), and there was no significant difference (P>0.05) at the other time points. At last follow-up, according to the ASIA grading, the effective improvement rate was 86% (18/21) in the n-HA/PA66 group and 90% (18/20) in the autologous iliac group, with no significant difference (χ²=0.176, P=0.675). Imaging review showed that grade Ⅰ bony fusion was obtained in both groups, and the fusion time of bone graft in the n-HA/PA66 group was significantly longer than that in the autologous iliac bone group (P<0.05). There was no significant difference in the Cobb angle at each time point between the two groups (P>0.05). No recurrence of tuberculosis, loosening or fracture of the internal fixator, or displacement of the bone graft was observed during follow-up. Conclusion In elderly patients with lumbar spine tuberculosis, the n-HA/PA66 bioactive support combined with allogeneic bone graft can effectively restore and maintain the fusion segment height and physiological curvature of the lumbar spine, and the fusion rate of bone graft is similar to that of autologous iliac bone, which can achieve better effectiveness.

Citation： YE Jiekai, FEI Jun, LAI Zhen, ZHANG Peng, HU Jinping, HU Shengping, ZHANG Chenwei. Comparison of nano-hydroxyapatite/polyamide 66 bioactive support and autologous iliac bone in bone grafting and fusion for elderly patients with lumbar tuberculosis. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(3): 296-304. doi: 10.7507/1002-1892.202110088 Copy

1.	Ding C, Wang S, Shangguan Y, et al. Epidemic trends of tuberculosis in China from 1990 to 2017: Evidence from the global burden of disease study. Infect Drug Resist, 2020, 13: 1663-1672.
2.	Yang S, Yu Y, Ji Y, et al. Multi-drug resistant spinal tuberculosis-epidemiological characteristics of in-patients: a multicentre retrospective study. Epidemiol Infect, 2020, 148: e11. doi: 10.1017/S0950268820000011.
3.	Liu Z, Zhang P, Li W, et al. Posterior-only vs. combined posterior-anterior approaches in treating lumbar and lumbosacral spinal tuberculosis: a retrospective study with minimum 7-year follow-up. J Orthop Surg Res, 2020, 15(1): 99. doi: 10.1186/s13018-020-01616-7.
4.	Chen G, Xin B, Yin M, et al. Biomechanical analysis of a novel height-adjustable nano-hydroxyapatite/polyamide-66 vertebral body: a finite element study. J Orthop Surg Res, 2019, 14(1): 368. doi: 10.1186/s13018-019-1432-2.
5.	Ayele BA, Wako A, Tadesse J, et al. Pott’s paraplegia and role of neuroimaging in resource limited setting: A case report and brief review of the literatures. J Clin Tuberc Other Mycobact Dis, 2021, 25: 100283. doi: 10.1016/j.jctube.2021.100283.
6.	Bridwell KH, Lenke LG, McEnery KW, et al. Anterior fresh frozen structural allografts in the thoracic and lumbar spine. Do they work if combined with posterior fusion and instrumentation in adult patients with kyphosis or anterior column defects? Spine (Phila Pa 1976), 1995, 20(12): 1410-1418.
7.	Dunn RN, Ben Husien M. Spinal tuberculosis: review of current management. Bone and Joint Journal, 2018, 100-B(4): 425-431.
8.	崔旭, 馬遠征, 陳興, 等. 老年脊柱結核患者的臨床特點和術式選擇. 中華骨科雜志, 2014, 34(2): 189-195.
9.	Teo AKJ, Singh SR, Prem K, et al. Duration and determinants of delayed tuberculosis diagnosis and treatment in high-burden countries: a mixed-methods systematic review and meta-analysis. Respir Res, 2021, 22(1): 251. doi: 10.1186/s12931-021-01841-6.
10.	Zhang HQ, Li M, Wang YX, et al. Minimum 5-year follow-up outcomes for comparison between titanium mesh cage and allogeneic bone graft to reconstruct anterior column through posterior approach for the surgical treatment of thoracolumbar spinal tuberculosis with kyphosis. World Neurosurg, 2019, 127: e407-e415.
11.	Fan J, Lan T, Tang K, et al. The comparative influence of 2 and 4 weeks preoperative antituberculosis treatment on spinal tuberculosis surgery: A multicenter, prospective, randomized clinical trial. Infect Dis Ther, 2021, 10(3): 1451-1463.
12.	Sun D, Zhang ZH, Mei G, et al. Comparison of anterior only and combined anterior and posterior approach in treating lumbosacral tuberculosis. Sci Rep, 2019, 9(1): 18475. doi: 10.1038/s41598-019-53800-3.
13.	Wu W, Li Z, Wang S, et al. One-stage surgical treatment for consecutive multisegment thoracic spinal tuberculosis with kyphosis by posterior-only debridement, interbody fusion, and instrumentation. World Neurosurg, 2019, 128: e238-e244.
14.	Li Y, Du Y, Ji A, et al. The clinical effect of manual reduction combined with internal fixation through Wiltse paraspinal approach in the treatment of thoracolumbar fracture. Orthop Surg, 2021, 13(8): 2206-2215.
15.	陳小明, 冷晶晶, 劉國萍, 等. 經皮椎弓根釘內固定聯合擴張通道微創側方小切口病灶清除椎間植骨治療腰椎結核. 中國修復重建外科雜志, 2021, 35(1): 46-50.
16.	Ying XZ, Shi SY, Zheng Q, et al. Treatment of lumbar tuberculosis by mini-open anterior approach focal cleaning combined with posterior internal fixation. Med Sci Monit, 2017, 23: 4158-4165.
17.	王旭, 李沐風, 朱宇航, 等. 頸椎結核手術治療中內植物的應用進展. 中國修復重建外科雜志, 2022, 36(1): 122-126.
18.	盧騰, 高中洋, 賀西京, 等. 新型解剖型鈦籠可提高終板的支撐強度: 基于影像學及生物力學方法. 南方醫科大學學報, 2019, 39(4): 409-414.
19.	An TY, Kim JY, Lee YS. Risk factors and radiologic changes in subsidence after single-level anterior cervical corpectomy: A minimum follow-up of 2 years. Korean J Neurotrauma, 2021, 17(2): 126-135.
20.	Li S, Huan Y, Zhu B, et al. Research progress on the biological modifications of implant materials in 3D printed intervertebral fusion cages. J Mater Sci Mater Med, 2021, 33(1): 2. doi: 10.1007/s10856-021-06609-4.
21.	吳家昌, 李修往, 方國芳. 3D打印人工椎體在脊柱腫瘤手術中的設計及初步應用. 中華創傷骨科雜志, 2020, 22(10): 855-861.
22.	Migliorini F, Cuozzo F, Torsiello E, et al. Autologous bone grafting in trauma and orthopaedic surgery: an evidence-based narrative review. J Clin Med, 2021, 10(19): 4347. doi: 10.3390/jcm10194347.
23.	Migliorini F, La Padula G, Torsiello E, et al. Strategies for large bone defect reconstruction after trauma, infections or tumour excision: a comprehensive review of the literature. Eur J Med Resh, 2021, 26(1): 118. doi: 10.1186/s40001-021-00593-9.
24.	Zhu G, Zhang T, Chen M, et al. Bone physiological microenvironment and healing mechanism: basis for future bone-tissue engineering scaffolds. Bioact Mater, 2021, 6(11): 4110-4140.
25.	Xiong Y, Ren C, Zhang B, et al. Analyzing the behavior of a porous nano-hydroxyapatite/polyamide 66 (n-ha/pa66) composite for healing of bone defects. Int J Nanomedicine, 2014, 9: 485-494.
26.	修鵬, 宋躍明, 李濤, 等. 納米羥基磷灰石/聚酰胺66在胸腰椎結核病灶清除術后椎體重建應用中的長期臨床觀察. 中國脊柱脊髓雜志, 2020, 30(10): 888-895.
27.	Zhao W, Li Y, Zhou A, et al. Controlled release of basic fibroblast growth factor from a peptide biomaterial for bone regeneration. R Soc Open Sci, 2020, 7(4): 191830. doi: 10.1098/rsos.191830.
28.	Zhong W, Liang X, Luo X, et al. Imaging evaluation of nano-hydroxyapatite/polyamide 66 strut in cervical construction after 1-level corpectomy: a retrospective study of 520 patients. Eur J Med Res, 2020, 25(1): 38. doi: 10.1186/s40001-020-00440-3.

1. Ding C, Wang S, Shangguan Y, et al. Epidemic trends of tuberculosis in China from 1990 to 2017: Evidence from the global burden of disease study. Infect Drug Resist, 2020, 13: 1663-1672.
2. Yang S, Yu Y, Ji Y, et al. Multi-drug resistant spinal tuberculosis-epidemiological characteristics of in-patients: a multicentre retrospective study. Epidemiol Infect, 2020, 148: e11. doi: 10.1017/S0950268820000011.
3. Liu Z, Zhang P, Li W, et al. Posterior-only vs. combined posterior-anterior approaches in treating lumbar and lumbosacral spinal tuberculosis: a retrospective study with minimum 7-year follow-up. J Orthop Surg Res, 2020, 15(1): 99. doi: 10.1186/s13018-020-01616-7.
4. Chen G, Xin B, Yin M, et al. Biomechanical analysis of a novel height-adjustable nano-hydroxyapatite/polyamide-66 vertebral body: a finite element study. J Orthop Surg Res, 2019, 14(1): 368. doi: 10.1186/s13018-019-1432-2.
5. Ayele BA, Wako A, Tadesse J, et al. Pott’s paraplegia and role of neuroimaging in resource limited setting: A case report and brief review of the literatures. J Clin Tuberc Other Mycobact Dis, 2021, 25: 100283. doi: 10.1016/j.jctube.2021.100283.
6. Bridwell KH, Lenke LG, McEnery KW, et al. Anterior fresh frozen structural allografts in the thoracic and lumbar spine. Do they work if combined with posterior fusion and instrumentation in adult patients with kyphosis or anterior column defects? Spine (Phila Pa 1976), 1995, 20(12): 1410-1418.
7. Dunn RN, Ben Husien M. Spinal tuberculosis: review of current management. Bone and Joint Journal, 2018, 100-B(4): 425-431.
8. 崔旭, 馬遠征, 陳興, 等. 老年脊柱結核患者的臨床特點和術式選擇. 中華骨科雜志, 2014, 34(2): 189-195.
9. Teo AKJ, Singh SR, Prem K, et al. Duration and determinants of delayed tuberculosis diagnosis and treatment in high-burden countries: a mixed-methods systematic review and meta-analysis. Respir Res, 2021, 22(1): 251. doi: 10.1186/s12931-021-01841-6.
10. Zhang HQ, Li M, Wang YX, et al. Minimum 5-year follow-up outcomes for comparison between titanium mesh cage and allogeneic bone graft to reconstruct anterior column through posterior approach for the surgical treatment of thoracolumbar spinal tuberculosis with kyphosis. World Neurosurg, 2019, 127: e407-e415.
11. Fan J, Lan T, Tang K, et al. The comparative influence of 2 and 4 weeks preoperative antituberculosis treatment on spinal tuberculosis surgery: A multicenter, prospective, randomized clinical trial. Infect Dis Ther, 2021, 10(3): 1451-1463.
12. Sun D, Zhang ZH, Mei G, et al. Comparison of anterior only and combined anterior and posterior approach in treating lumbosacral tuberculosis. Sci Rep, 2019, 9(1): 18475. doi: 10.1038/s41598-019-53800-3.
13. Wu W, Li Z, Wang S, et al. One-stage surgical treatment for consecutive multisegment thoracic spinal tuberculosis with kyphosis by posterior-only debridement, interbody fusion, and instrumentation. World Neurosurg, 2019, 128: e238-e244.
14. Li Y, Du Y, Ji A, et al. The clinical effect of manual reduction combined with internal fixation through Wiltse paraspinal approach in the treatment of thoracolumbar fracture. Orthop Surg, 2021, 13(8): 2206-2215.
15. 陳小明, 冷晶晶, 劉國萍, 等. 經皮椎弓根釘內固定聯合擴張通道微創側方小切口病灶清除椎間植骨治療腰椎結核. 中國修復重建外科雜志, 2021, 35(1): 46-50.
16. Ying XZ, Shi SY, Zheng Q, et al. Treatment of lumbar tuberculosis by mini-open anterior approach focal cleaning combined with posterior internal fixation. Med Sci Monit, 2017, 23: 4158-4165.
17. 王旭, 李沐風, 朱宇航, 等. 頸椎結核手術治療中內植物的應用進展. 中國修復重建外科雜志, 2022, 36(1): 122-126.
18. 盧騰, 高中洋, 賀西京, 等. 新型解剖型鈦籠可提高終板的支撐強度: 基于影像學及生物力學方法. 南方醫科大學學報, 2019, 39(4): 409-414.
19. An TY, Kim JY, Lee YS. Risk factors and radiologic changes in subsidence after single-level anterior cervical corpectomy: A minimum follow-up of 2 years. Korean J Neurotrauma, 2021, 17(2): 126-135.
20. Li S, Huan Y, Zhu B, et al. Research progress on the biological modifications of implant materials in 3D printed intervertebral fusion cages. J Mater Sci Mater Med, 2021, 33(1): 2. doi: 10.1007/s10856-021-06609-4.
21. 吳家昌, 李修往, 方國芳. 3D打印人工椎體在脊柱腫瘤手術中的設計及初步應用. 中華創傷骨科雜志, 2020, 22(10): 855-861.
22. Migliorini F, Cuozzo F, Torsiello E, et al. Autologous bone grafting in trauma and orthopaedic surgery: an evidence-based narrative review. J Clin Med, 2021, 10(19): 4347. doi: 10.3390/jcm10194347.
23. Migliorini F, La Padula G, Torsiello E, et al. Strategies for large bone defect reconstruction after trauma, infections or tumour excision: a comprehensive review of the literature. Eur J Med Resh, 2021, 26(1): 118. doi: 10.1186/s40001-021-00593-9.
24. Zhu G, Zhang T, Chen M, et al. Bone physiological microenvironment and healing mechanism: basis for future bone-tissue engineering scaffolds. Bioact Mater, 2021, 6(11): 4110-4140.
25. Xiong Y, Ren C, Zhang B, et al. Analyzing the behavior of a porous nano-hydroxyapatite/polyamide 66 (n-ha/pa66) composite for healing of bone defects. Int J Nanomedicine, 2014, 9: 485-494.
26. 修鵬, 宋躍明, 李濤, 等. 納米羥基磷灰石/聚酰胺66在胸腰椎結核病灶清除術后椎體重建應用中的長期臨床觀察. 中國脊柱脊髓雜志, 2020, 30(10): 888-895.
27. Zhao W, Li Y, Zhou A, et al. Controlled release of basic fibroblast growth factor from a peptide biomaterial for bone regeneration. R Soc Open Sci, 2020, 7(4): 191830. doi: 10.1098/rsos.191830.
28. Zhong W, Liang X, Luo X, et al. Imaging evaluation of nano-hydroxyapatite/polyamide 66 strut in cervical construction after 1-level corpectomy: a retrospective study of 520 patients. Eur J Med Res, 2020, 25(1): 38. doi: 10.1186/s40001-020-00440-3.

Chinese Journal of Reparative and Reconstructive Surgery

Comparison of nano-hydroxyapatite/polyamide 66 bioactive support and autologous iliac bone in bone grafting and fusion for elderly patients with lumbar tuberculosis

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