表面钛涂层椎间融合系统治疗腰椎管狭窄症伴腰椎不稳症  

Treatment of degenerative lumbar stenosis with segmental instability using titanium-coating interbody fusion system

作　　者：张亚峰[1] 杨惠林[1] 唐天驷[1] 杨同其[1] 徐耀增[1] 陈亮[1] 朱雪松[1] 

机构地区：[1]苏州大学附属第一医院骨科,215006

出　　处：《中华骨科杂志》2008年第3期192-196,共5页Chinese Journal of Orthopaedics

摘　　要：目的探讨应用解剖型表面钛涂层椎间融合系统治疗腰椎管狭窄症伴腰椎不稳症的临床疗效。方法回顾总结2003年1月至2004年6月采用解剖型表面钛涂层椎间融合系统治疗腰椎管狭窄症伴腰椎不稳症46例，男19例，女27例；年龄53-71岁，平均62岁。融合节段：L3，4 5例，L4，5 29例，L5S1 10例，L3，4＋L4，5 1例，L4，5＋L5S1 1例。行后路椎管减压、椎体间融合术，均植入2枚解剖型表面微孔钛涂层实心融合器，全部加用椎弓根螺钉内固定并辅以后外侧植骨，椎间隙不予植骨。测量术后6、12及24个月时椎间隙高度丢失情况，融合节段稳定性以及融合器周围成骨情况并进行对比，采用JOA评分及Oswestry功能障碍指数进行临床疗效评定。结果全部病例均得到随访，随访时间25-31个月，平均27个月。术后椎间隙高度得到满意恢复，随访中未发现有明显丢失，融合节段稳定性良好。JOA评分及ODI指数均显示临床疗效良好。2例出现术中硬脊膜撕裂，未有遗留神经症状。结论解剖型表面钛涂层椎间融合器和既往的中空融合器相比，在提供稳定的融合环境的同时有利于新生骨的形成，有效地提高了融合率，应用于腰椎管狭窄症伴腰椎不稳症的治疗是安全，有效的方法。Objective To study the clinical outcomes of using anatomic titanium-coating fusion system in degenerative lumbar stenosis with segmental instability. Methods From January 2003 to June 2004, 46 cases with degenerative lumbar stenosis with segmental instability were treated by spinal canal decompression and posterior lumbar interbody fusion （PLIF） using anatomic titanium-coating fusion system. 19 males and 27 females with the average age of 62 years were included. The fusion segments were L3,4 in 5 patients,L4,5 in 29,L5S1 in IO,L3,4＋L4,5 in 1 and L4,5＋L5S1 in 1. In all cases double cages were implanted with additional posterolateral bone graft and pedicle screw systems were supplemented. At 6, 12 and 24 months postoperatively the average disc space height, the amount of sagittal rotation observed between the extremes of movement （on flexion-extension radiographs） and the bone formation around the fusion cages in different follow-up periods were measured and compared. The JOA Score and Oswestry Disability Questionnaire were used to evaluate the clinical outcomes. Results All cases were followed and the follow-up period ranged from 25 to 31 months with an average of 27 months. According to the JOA and Oswestry Disability Index scoring system, satisfactory clinical outcomes were achieved. There were significant retrieve of disc space height and foraminal height, and the meaningful loss of disc height was not found in following period. The restoring of the amount of sagittal rotation observed between the extremes of movement was achieved which shows the satisfied segmental stability. 2 patients had dural laceration and the neurological deficits were recovered within 3 weeks. Conclusion The anatomic titanium-coating fusion system can accelerates interbody fusion due to osteointegration of the vertebral endplates by titanium coating without additional interbody bone grafts which can increase fusion rate in PLIF. It is safe and effective in treating the lumbar stenosis with instability, which can lead to sati

关 键 词：椎管狭窄 脊柱融合术 腰椎 

分 类 号：R687.3[医药卫生—骨科学]