可膨胀性椎间融合器在腰椎退行性疾患治疗中的应用  

Application of expandable spinal spacer in lumbar degenerative disc disease

作　　者：王文军[1] 姚女兆[1] 王鹿山[1] 胡文凯[1] 刘利乐[1] 

机构地区：[1]南华大学附属第一医院脊柱外科,湖南衡阳421001

出　　处：《中华骨科杂志》2007年第12期I0009-I0012,共4页Chinese Journal of Orthopaedics

摘　　要：目的探讨可膨胀性椎间融合器B—twin应用在严重退行性腰椎疾患手术中的临床疗效。方法2004年6月至2006年12月，对43例退行性腰椎疾患患者在后路椎间盘镜下或经皮穿刺行椎间盘摘除B－twin椎间融合术。男28例，女15例；年龄26-23岁，平均47岁。腰椎间盘突出合并椎管狭窄27例，I度以内滑脱5例，腰椎不稳11例。后路椎间盘镜下操作35例，后外侧经皮穿刺操作8例。常规椎间盘镜下椎间盘切除或经皮髓核切除后，处理椎体软骨终板，并撑开椎间隙。在“C”型臂X线机透视下，根据椎间隙撑开的程度选择合适尺寸的可膨胀性椎间融合器插入椎间隙内，一期椎间融合器外植骨融合。结果随访时间12-30个月（平均18个月），随访期间31例已达骨性融合，其中大部分B—twin椎间融合器位置下沉不明显（10％以内），仅2例下沉明显（达20％－30％），无明显临床症状。按中华医学会骨科学分会脊柱学组腰背痛手术评定标准评价：优3l例，良8例，可3例，差l例，症状改善优良率达9l％。结论可膨胀性椎间融合器B—twin在退行性腰椎疾患治疗中具有创伤小、植骨融合率高且临床症状恢复可靠的优点。Objective To explore the clinical outcome of the expandable spinal spacer（B-twin） applying in lumbar degenerative disc disease. Methods From June 2004 to December 2006, 43 consecutive patients with lumbar degenerative disc disease were included in this study. There were 28 males and 15 females, with average age of 47 years （range 26-63 years）. 35 of the 43 patients underwent micro-endoscopic discectomy. 8 cases of all underwent percutaneous puncture. Following a routine micro-endoscopic discectomy or percutaneous nucleotomy and endplate curettage were meticulously carried out. The intervertebral space was packed with autograft cancellous bone cut from lumbar delivered through a 5 mm diameter funnel. The B-twin expandable spinal spacer was introduced into the intervertebral space bilaterally and was then expanded. Both stages were monitored by C-arm fluoroscopy. Results All patients were evaluated after a follow-up of 12 to 30 months（mean 18 months）. 31 cases achieved bone graft fusion during the period of follow-up. The subsidence degree of the B-twin was 20%-30% in 2 cases, the other cases were less than 10%. According to clinical outcome judgement criterion of surgical treatment for low back pain formulated by the spine group of Chinese Orthopaedic Association, excellent in 31 cases, good 8 cases, fair 3 cases, poor 1 case, the excellent and good rate was 91%. Conclusion Posterior lumbar interbody fusion using a newly designed B-twin expandable fusion cage minimize surgical soft tissue trauma and blood loss. The technique can obtain satisfactory outcome in the treatment of degenerative disc disease.

关 键 词：椎间盘移位 腰椎 外科手术 微创性 脊柱融合术 

分 类 号：R686[医药卫生—骨科学]