三种腰椎椎间融合器后路应用的比较研究
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摘要
目的比较研究柱状螺纹融合器TFC/BAK、方形碳纤维融合器CFRP和垂直钛网融合器Harms Cage结合短节段椎弓根钉固定应用于腰椎退行性疾病的临床疗效和影像学改变。
方法对2002年1月～2003年12月间所采用后路椎间融合器植入附加椎弓根钉固定行单节段和两节段椎间融合术并具完整资料的118例下腰椎退行性疾病患者进行回顾性分析研究,其中包括柱状螺纹融合器组(A组)42例(44节段),碳纤维融合器组(B组)62例(70节段),钛网融合器组(C组)14例(16节段)。对三组患者手术时间、术中出血量、术后住院时间、手术并发症发生率和融合器沉陷率以及融合率分别进行比较;根据JOA评分和Oswestry功能障碍指数判断三组患者临床疗效并加以比较;根据腰椎侧位X线片,分别测量三组患者术前、术后及随访终末的手术节段前凸角、椎间高度和腰椎前凸角,对所测指标进行分析比较。
结果三组手术时间、术中出血量和术后住院时间以及手术并发症发生率无显著性差异。随访终末发现A组9例、B组1例出现融合器向椎体内明显沉陷, A组融合器沉陷率显著高于B、C两组。三组随访终末的融合率、JOA评分好转率、ODI改善率和临床疗效优良率均无显著性差异。三组患者手术节段前凸角、椎间高度和腰椎前凸角,术前比较无显著差异; A组节段前凸角术后增加最少,与B、C两组比较有显著性差异(P<0.05),随访终末较术后有明显丢失,与B、C组比较存在显著性差异(P<0.05)。三组术后手术节段平均椎间高度均显著增加,比较无显著性差异;A组随访终末椎间高度较术后有明显降低,与B、C组比较有显著性差异(P<0.05)。腰椎前凸角,术前、术后和随访终末三组间比较均无显著性差异;三组术后均较术前增加(P<0.05),但螺纹融合器组术后增加值最少,和其他两组比较有统计学意义(F=4.78,P<0.05)。
结论三种椎间融合器结合短节段椎弓根螺钉固定的后路腰椎椎间融合术均为治疗腰椎退行性疾病的有效方法;方形碳纤维和垂直钛网椎间融合器在恢复和维持融合节段椎间高度和节段前凸角方面明显优于水平柱状螺纹融合器。
Objective To compare segmental lordosis and disc height at each fused level and total lumbar lordosis, as well as the clinic results of patients undergoing posterior interbody arthrodesis using cylindrical threaded cage (TFC/BAK), rectangular carbon fiber cage (CFRP) or vertical titanium mesh cages supplemented with short-segmented transpedicular screw in the treatment of degenerated lumbar disorders.
Methods 118 consecutive patients (130 spinal segments) had undergone single- or two-level lumbar or lumbosacral interbody fusion combined with posterior transpedicular instrumentation for treatmenting degenerated lumbar disease using either cylindrical threaded cages (42 patients,44 segments in Group A), rectangular carbon fiber cages (62 patients,70 segments in group B), or vertically oriented titanium mesh cages (14 patients,16 segments in groupC). Standing lateral lumbar radiographs were measured preoperatively, immediately postoperatively (within 1 week), and latest follow-up for segmental lordosis and disc height at each fused level undergoing posterior interbody arthrodesis and total lumbar lordosis. A comparison was made between three groups among the data of lumbar lordosis angle, height of intervertebral space and segemental lordosis angle preoperatively, postoperatively and latest follow-up respectively. Meanwhile,the clinical results, the fusion rate and complications between three groups postoperative were compared.
Results The operation time and amount of bleeding had no significant difference for three groups, There were no significant difference in terms of the rate of improvement JOA score or ODI, the rat of satisfactory clinical results and complications of nervous system for three groups. Nine cases of TFC/ BAK and one case of CFRP subsided into the vertebra to some extent. Preoperative segmental lordosis, height of intervertebral space, and total lumbar lordosis angle had no difference for three groups. The immediate postperative disc height had no difference for three groups.The disc height has significant difference for Group A compared with group B and group C, and there was a significant mean loss for Group A at latest follow-up. Postoperative segmental lordosis was improved for three groups, but there were significant difference for group A compared with group B and group C. There were significant difference for Group A compared with group B and group C, and a significant mean lordotic loss for Group A at latest follow-up. Postoperative improvement of total lumbar lordosis angle had significant difference for Group A compared with group B and group C.
Conclusion Supplemented with short-segmented transpedicular screw, posterior lumbar
方法对2002年1月～2003年12月间所采用后路椎间融合器植入附加椎弓根钉固定行单节段和两节段椎间融合术并具完整资料的118例下腰椎退行性疾病患者进行回顾性分析研究,其中包括柱状螺纹融合器组(A组)42例(44节段),碳纤维融合器组(B组)62例(70节段),钛网融合器组(C组)14例(16节段)。对三组患者手术时间、术中出血量、术后住院时间、手术并发症发生率和融合器沉陷率以及融合率分别进行比较;根据JOA评分和Oswestry功能障碍指数判断三组患者临床疗效并加以比较;根据腰椎侧位X线片,分别测量三组患者术前、术后及随访终末的手术节段前凸角、椎间高度和腰椎前凸角,对所测指标进行分析比较。
结果三组手术时间、术中出血量和术后住院时间以及手术并发症发生率无显著性差异。随访终末发现A组9例、B组1例出现融合器向椎体内明显沉陷, A组融合器沉陷率显著高于B、C两组。三组随访终末的融合率、JOA评分好转率、ODI改善率和临床疗效优良率均无显著性差异。三组患者手术节段前凸角、椎间高度和腰椎前凸角,术前比较无显著差异; A组节段前凸角术后增加最少,与B、C两组比较有显著性差异(P<0.05),随访终末较术后有明显丢失,与B、C组比较存在显著性差异(P<0.05)。三组术后手术节段平均椎间高度均显著增加,比较无显著性差异;A组随访终末椎间高度较术后有明显降低,与B、C组比较有显著性差异(P<0.05)。腰椎前凸角,术前、术后和随访终末三组间比较均无显著性差异;三组术后均较术前增加(P<0.05),但螺纹融合器组术后增加值最少,和其他两组比较有统计学意义(F=4.78,P<0.05)。
结论三种椎间融合器结合短节段椎弓根螺钉固定的后路腰椎椎间融合术均为治疗腰椎退行性疾病的有效方法;方形碳纤维和垂直钛网椎间融合器在恢复和维持融合节段椎间高度和节段前凸角方面明显优于水平柱状螺纹融合器。
Objective To compare segmental lordosis and disc height at each fused level and total lumbar lordosis, as well as the clinic results of patients undergoing posterior interbody arthrodesis using cylindrical threaded cage (TFC/BAK), rectangular carbon fiber cage (CFRP) or vertical titanium mesh cages supplemented with short-segmented transpedicular screw in the treatment of degenerated lumbar disorders.
Methods 118 consecutive patients (130 spinal segments) had undergone single- or two-level lumbar or lumbosacral interbody fusion combined with posterior transpedicular instrumentation for treatmenting degenerated lumbar disease using either cylindrical threaded cages (42 patients,44 segments in Group A), rectangular carbon fiber cages (62 patients,70 segments in group B), or vertically oriented titanium mesh cages (14 patients,16 segments in groupC). Standing lateral lumbar radiographs were measured preoperatively, immediately postoperatively (within 1 week), and latest follow-up for segmental lordosis and disc height at each fused level undergoing posterior interbody arthrodesis and total lumbar lordosis. A comparison was made between three groups among the data of lumbar lordosis angle, height of intervertebral space and segemental lordosis angle preoperatively, postoperatively and latest follow-up respectively. Meanwhile,the clinical results, the fusion rate and complications between three groups postoperative were compared.
Results The operation time and amount of bleeding had no significant difference for three groups, There were no significant difference in terms of the rate of improvement JOA score or ODI, the rat of satisfactory clinical results and complications of nervous system for three groups. Nine cases of TFC/ BAK and one case of CFRP subsided into the vertebra to some extent. Preoperative segmental lordosis, height of intervertebral space, and total lumbar lordosis angle had no difference for three groups. The immediate postperative disc height had no difference for three groups.The disc height has significant difference for Group A compared with group B and group C, and there was a significant mean loss for Group A at latest follow-up. Postoperative segmental lordosis was improved for three groups, but there were significant difference for group A compared with group B and group C. There were significant difference for Group A compared with group B and group C, and a significant mean lordotic loss for Group A at latest follow-up. Postoperative improvement of total lumbar lordosis angle had significant difference for Group A compared with group B and group C.
Conclusion Supplemented with short-segmented transpedicular screw, posterior lumbar
引文
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87 Wolfla CE, Maiman DJ, Coufal FJ, et al. Retroperitoneal lateral lumbar interbody fusion with titanium threaded fusion cages[J]. J Neurosurg, 2002, 96(1 Suppl):50-55.
88 Foley K, Lefkowtz MA. Advance in minimally invasive spine surgery[J]. Clin Neursurg, 2002, 49(15):499-517.
89 Lowe TG, Tahernia AD, Brien MF, et al. unilateral Transforaminal approach for posteriolumbar interbody fusion[J]. J Spinal Disord Tech, 2002, 15(1): 21-28.
90 Rosenberg WS, Mummaneni PV. Transforaminal approach for posteriolumbar interbody fusion: technique, complication, and early results[J]. Neurosurg, 2001, 48(3): 569-574.
91 Wang JC, Mummaneni PV, Haid RW.Current Treatment Strategies for the Painful Lumbar Motion Segment Posterolateral Fusion Versus Interbody Fusion[J]. Spine, 2005, 30(16S): 33-43.
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94 Kuslich SD, Ulstrom CL, Griffith SL, Ahern JW, Dowdle JD. The Bagby and Kuslich method of lumbar interbody fusion: History, techniques, and 2-year follow-up results of a United States prospective, multicenter trial[J]. Spine, 1998, 23(11):1267-1278.
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96 刘海鹰, 周殿阁,王会民.椎间融合器在腰椎退行性病变中应用的比较研究.中华外科杂志[J].2004, 42(21):1316-1318.
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98 Lai PL, Chen LH, Niu CC, et al. Effect of Postoperative Lumbar Sagittal Alignment on the Development of Adjacent Instability[J]. J Spinal Disord, 2004, 17(5):353–357.
99 Christensen FB, Hansen ES, Eiskj?r SP, et al.Circumferential Lumbar Spinal Fusion With Brantigan Cage Versus Posterolateral Fusion With Titanium Cotrel–Dubousset Instrumentation.A Prospective, Randomized Clinical Study of 146 Patients[J]. Spine, 2002, 27(23): 2674-2683.
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104 孙志明,赵合元,董荣华.单枚斜向cage置入加椎弓根螺钉固定治疗腰椎滑脱症的疗效分析[J].中国脊柱脊髓杂志,2003,13(7): 429-431.
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89 Lowe TG, Tahernia AD, Brien MF, et al. unilateral Transforaminal approach for posteriolumbar interbody fusion[J]. J Spinal Disord Tech, 2002, 15(1): 21-28.
90 Rosenberg WS, Mummaneni PV. Transforaminal approach for posteriolumbar interbody fusion: technique, complication, and early results[J]. Neurosurg, 2001, 48(3): 569-574.
91 Wang JC, Mummaneni PV, Haid RW.Current Treatment Strategies for the Painful Lumbar Motion Segment Posterolateral Fusion Versus Interbody Fusion[J]. Spine, 2005, 30(16S): 33-43.
92 孙常太,张启伟,申剑. 经X-tube微创腰椎椎弓根螺钉内固定椎间融合术手术体会[J]. 脊柱外科杂志, 2004, 2 (3): 185-186.
93 Elias WJ, Simmons NE, Kaptain GJ, et al. Complications of posterior lumbar interbody fusion when using a titanium threaded cage device[J]. J Neurosurg, 2000, 93(suppl): 45-52.
94 Kuslich SD, Ulstrom CL, Griffith SL, Ahern JW, Dowdle JD. The Bagby and Kuslich method of lumbar interbody fusion: History, techniques, and 2-year follow-up results of a United States prospective, multicenter trial[J]. Spine, 1998, 23(11):1267-1278.
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96 刘海鹰, 周殿阁,王会民.椎间融合器在腰椎退行性病变中应用的比较研究.中华外科杂志[J].2004, 42(21):1316-1318.
97 郝 勇,周 跃.目前临床应用的腰椎椎间融合器的现状与进展[J].骨与关节损伤杂志,2003,18(12): 854-857.
98 Lai PL, Chen LH, Niu CC, et al. Effect of Postoperative Lumbar Sagittal Alignment on the Development of Adjacent Instability[J]. J Spinal Disord, 2004, 17(5):353–357.
99 Christensen FB, Hansen ES, Eiskj?r SP, et al.Circumferential Lumbar Spinal Fusion With Brantigan Cage Versus Posterolateral Fusion With Titanium Cotrel–Dubousset Instrumentation.A Prospective, Randomized Clinical Study of 146 Patients[J]. Spine, 2002, 27(23): 2674-2683.
100 Steffen T,Tsantrizos A, Aebi M.Effect of Implant Design and Endplate Preparation on the Compressive Strength of Interbody Fusion Constructs[J]. Spine, 2000, 25(9):1077- 1084.
101 Kozak JA, Heilman AE, O’Brien JP. Anterior lumbar fusion options: Technique and graft materials[J]. Clin Orthop, 1994, 300: 45-51.
102 Lin PM. Posterior lumbar interbody fusion technique: Complications andpitfalls[J]. Clin Orthop, 1985, 193: 90-102.
103 陈亮,唐天驷,杨惠林.后路BAK椎间融合术治疗腰椎滑脱症的并发症分析[J].中华骨科杂志,2002,22(6):237-242.
104 孙志明,赵合元,董荣华.单枚斜向cage置入加椎弓根螺钉固定治疗腰椎滑脱症的疗效分析[J].中国脊柱脊髓杂志,2003,13(7): 429-431.
105 Kim KS, Yang TK,Lee JC.Radiological Changes in the Bone Fusion Site After Posterior Lumbar Interbody Fusion Using Carbon Cages Impacted With Laminar Bone Chips: Follow-Up Study Over More Than 4 Years[J]. Spine, 2005, 30(6): 655-660.
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