单、双箱型椎间融合器在PLIF手术治疗腰椎不稳症中的比较研究  

The clinical research of PLIF with one or two cages in treatment of lumbar spinal instability

作　　者：李钦亮[1] 刘艺[1] 陈鸣[1] 陈金传[1] 邹国友[1] 

机构地区：[1]徐州医学院附属连云港医院骨科,江苏连云港222000

出　　处：《颈腰痛杂志》2009年第5期393-396,共4页The Journal of Cervicodynia and Lumbodynia

基　　金：连云港市卫生局(07001)

摘　　要：目的应用单、双箱型椎间融合器(Cage)联合椎弓根内固定系统治疗腰椎不稳症,通过比较影像学变化及临床症状改善情况,探讨应用单枚箱型Cage联合椎弓根内固定系统进行椎间融合的可行性。方法在对56例单节段腰椎不稳症患者施行PLIF(Posterior lumar interbody fusion)手术,均行后路短节段椎弓根钉系统复位与内固定,实施单枚Cage椎体间植骨37例,双枚Cage椎体间植骨19例。统计两组手术的平均手术时间及术中出血量。用M-JOA评分的症状改善率评价患者治疗效果,并观察手术并发症。术前、术后及随访期间摄X线片,观察椎体间高度、整个腰椎前凸弧度、融合节段前凸弧度、融合节段间的滑移,并辅助CT判断植骨融合情况。结果单枚Cage植入组较双枚Cage植入组手术时间短(P<0.01),出血少(P<0.01)。术前术后的椎体间高度、整个腰椎前凸弧度、融合时间二组病例之间没有统计学意义(P>0.05)。两组下腰痛症状改善率无统计学意义(P>0.05)。两组骨融合率均为100%。结论使用单枚箱型Cage与双枚箱型Cage行椎间融合联合椎弓根内固定系统均是治疗腰椎不稳症的有效治疗方式,二者在缓解下腰部疼痛、椎间融合率方面效果显著。单枚箱型Cage行椎间融合联合椎弓根内固定系统行PLIF手术具有手术时间短,出血量少,创伤小,患者医疗费用少等优点,值得临床推广应用。Objective Observation of the clinical effect and radiological appraisal were carried of posterior lumbar interbody fusion with one cage and two cages in the treatment of lumbar spinal instability. To explore the feasible of application one cage in PLIF. Methods 56 cases of lumbar spinal instability underwent posterior lumbar interbody fusion with one cage （n=37） and two cages （n=19） combined pedical fixation were conducted to all patients. Observed the operation time, hemorrhage amount, the short period effect, and the intervertebral height and the lumbar lordotic angle preoperation and postoperateion. Followed regularly,judge the fusion and fusion time. Observe the changes of symptoms and evaluation M-JOA scoring system. Results Operation time was shorter and,hemorrhage amount was less in fusion with one cage than those infusion with two cage （P〈0.01）. Both of two kinds of operation had an satisfactory effect on the the height of intervertebral space,recoveried postoperation （P〈0.01）. The difference between two kinds of operation was not significant either（P〉0.05）. There was no difference in the symptom recovery rate based on M-JOA scoring system and the graft fusion rate between two groups. The bone fusion rate was 100% in two groups. Conclusion Both one or two cage in interbody lumbar fusion are effective to treat lumbar spinal instability. The interbody fusion with one cage produce the same surgical resuits, while it does decrease the trauma of operation.

关 键 词：椎间融合术 椎间融合器 腰椎不稳症 

分 类 号：R681.55[医药卫生—骨科学] R687.32[医药卫生—外科学]