融合器位置对侧方入路腰椎椎间融合术间接减压疗效的影像学评估  

Radiographic evaluation of the impact of cage position on indirect neural decompression in crenel lateral interbody fusion

作　　者：李君[1] 李方财[1] 陈其昕[1] 陈维善[1] 陈刚[1] 张宁[1] 陈临炜 李浩[1] Li Jun;Li Fangcai;Chen Qixin;Chen Weishan;Chen Gang;Zhang Ning;Chen Linwei;Li Hao(Department of Orthopaedics,The Second Affiliated Hospital of Medical College Zhejiang University,Hangzhou 310009,China)

机构地区：[1]浙江大学医学院附属第二医院骨科,杭州310009

出　　处：《中华骨科杂志》2019年第4期216-225,共10页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金(81702225);浙江省医药卫生重大科技计划(WKJ-ZJ-1903).

摘　　要：目的探讨椎间融合器位置对改良侧方入路腰椎椎体间融合术(crenel lateral interbody fusion,CLIF)间接减压效果及融合器沉降的影响。方法回顾性分析2016年11月至2018年2月应用CLIF技术治疗腰椎管狭窄症患者34例的病历资料,男18例,女16例;年龄52-75岁,平均(63.98±5.99)岁。34例共行腰椎椎体间融合60个节段。采用CT薄层扫描及多平面重建测量手术节段终板厚度,并绘制反映终板厚度分布的等高线图。根据融合器植入位置进行分组,将融合器位于椎间隙前1/3者定义为前置组,而融合器位于椎间隙中后2/3者定义为中后置组。影像学评估指标包括手术前后侧位X线片测量手术节段椎间隙角度和椎间隙前、后缘高度,CT片测量椎间孔高度,水平位MRI测量椎管面积。对影响手术节段角度变化值和椎管横截面积改变率的各因素进行单因素和多因素广义线性模型分析。结果34例患者均得到随访,随访时间6-18个月,平均(10.88±3.73)个月。椎间隙上位终板每一个点的平均厚度均明显大于下位终板的平均厚度。终板厚度等高线图示腰椎终板前方和侧前方有更多骨性终板较厚的区域。前置组共19个融合器,中后置组共41个融合器。前置组术后椎间隙前缘高度平均增加(3.38±3.38)mm,中后置组术后平均增加(1.83±3.08)mm,差异有统计学意义(t=0.43,P=0.04)。前置组术后手术节段角度平均增加2.93°±3.47°,中后置组术后平均增加0.73°±3.60°,差异有统计学意义(t=2.28,P=0.04)。两组术后的椎间隙后缘高度改变、椎间孔高度改变及手术节段椎管面积改善率的差异均无统计学意义。多因素分析显示融合器位置与椎间隙角度改变有关(β=1.24,P=0.03),与椎管面积改善率无关。末次随访时前置组融合器沉降率为15.79%(3/19),中后置组为24.39%(10/41),差异无统计学意义(χ^2=0.56,P=0.45)。结论腰椎终板前方和侧前方有更多骨性终板较厚的�Objective To explore the impact of cage position on indirect decompression and cage subsidence in crenel lateral interbody fusion (CLIF).Methods Retrospectively, 18 mens and 16 womens with a mean age of 63.98±5.99 years (range: 52-75 years) who underwent CLIF for lumbar stenosis by our surgical group during November 2016 and Feburary 2018 were reviewed. Sixty-two segments were included for radiographic evaluation. Endplates thickness was measured using high resolution computed tomography. By image processing, endplate thickness was measured at 10 equally distributed points on the mid-sagittal and mid-coronal planes, and two further planes were measured at an angle of 45° to both the first and second planes. Contour plots representing an isoline of endplate thickness was drawn based on those data. The cages were classified into anterior group and medium-posterior group. Radiographic evaluation included segmental angle, anterior and posterior disk heights, intervertebral foramen heights, and cross-sectional area of the spinal canal. To assess the factors affecting the postoperative segmental angle and cross-sectional area of the spinal canal, univariate and multivariate analysis were performed using the regression analysis model. Cage subsidence was recorded at the last follow-up.Results The mean follow-up time of those patients were 10.88±3.73 months (range: 6-18 months). At each spot, the mean thickness was significantly greater for the cranial endplate of disc than the caudal endplate. Contour plots show more areas of thick bony endplates in the anterior and anterolateral part of the endplate than the lateral and posterior part, especially for the cranial endplate. The cage was placed in the anterior area for 19 levels and medium-posterior for 41 levels. The mean increase of anterior disk height was 3.38±3.38 mm in anterior group and 1.83±3.08 mm in medium-posterior group(P=0.04). The mean increase of segmental angle was 2.93°±3.47°in anterior group and 0.73°±3.60° in medium-posterior group(P=0.04). N

关 键 词：腰椎 脊柱融合术 内固定器 手术后并发症 

分 类 号：R687.3[医药卫生—骨科学]