单枚和两枚融合器经单侧椎间孔椎体间融合术临床疗效及影像学表现的比较研究  

COMPARISON OF EFFECTIVENESS AND RADIOLOGICAL FEATURES BETWEEN SINGLE AND DOUBLE CAGE IMPLANTING THROUGH UNILATERAL TRANSFORAMINAL LUMBAR INTERBODY FUSION

作　　者：张顺聪[1,2] 崔健超[1] 杨志东[1] 梁德[1] 莫凌[1] 张志达[2] 唐永超[1] 林顺鑫 沈耿杨[2] 

机构地区：[1]广州中医药大学第一附属医院脊柱外科,广州510405 [2]广州中医药大学第一临床医学院

出　　处：《中国修复重建外科杂志》2015年第11期1389-1396,共8页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的 探讨单侧经椎间孔椎体间融合术（transforaminal lumbar interbody fusion,TLIF）中椎间隙植入单枚和2枚融合器对临床疗效及影像学表现的影响。方法 回顾性分析2013年1月-2014年10月行TLIF手术的患者,将104例符合纳入标准的患者分成植入单枚融合器组（传统组,64例76个节段）和植入2枚融合器组（改良组,56例70个节段）。两组患者年龄、性别、骨密度、手术节段等一般资料比较差异无统计学意义（P〉0.05）。术前及术后7 d、3个月、12个月分别行疼痛视觉模拟评分（VAS）、Oswestry功能障碍指数（ODI）评分及日本骨科协会（JOA）评分,评价患者主观感受。术后行腰椎CT检查测量责任椎间隙横断面的植骨面积（以评价椎间植骨量）、术侧及对侧椎间隙高度及其差值,并观察融合节段个数及椎间融合器下沉发生情况。结果 所有患者均获随访,随访时间9-18个月,平均12.85个月。两组术后各时间点VAS、ODI、JOA评分均较术前显著改善（P〈0.05）;除术后12个月传统组VAS及ODI评分略优于改良组（P〈0.05）外,其余各时间点两组间各评分比较差异均无统计学意义（P〉0.05）。术后7 d两组CT横断面植骨面积分别为（4.81±0.97）cm2和（5.94±1.17）cm2,差异有统计学意义（t=—6.365,P=0.000）。术后3、12个月传统组融合率分别为84.2%、92.1%,改良组分别为88.6%、94.3%,两组较为接近。两组术后双侧椎间隙高度均有明显改善,但术后3、12个月发现传统组出现较多的融合器下沉现象,发生率高达44.74%和47.37%,远高于改良组的11.43%和14.29%（P〈0.05）;并且在排除融合器下沉节段的影响下传统组中双侧椎间隙高度差较改良组显著（P〈0.05）。结论 单侧TLIF椎间植入单枚和2枚融合器均能明显改善临床症状,但植入2枚融合器能更好地维持椎间隙高度,减少融合器下沉及椎间隙倾斜等不良并发症发生。Objective To compare the effectiveness and imaging features between implanting single and double Cage into intervertebral body through unilateral transforaminal lumbar interbody fusion（TLIF）. Methods The clinical data were collected and analyzed from 104 patients who underwent unilateral TLIF between January 2013 and October 2014, who were divided into 2 groups： single Cage was implanted into intervertebral body in 64 cases（76 segments） in traditional group, and double Cage was implanted into intervertebral body in 56 cases（70 segments） in reformative group. There was no significant difference in age, gender, bone mineral density, operation segments between 2 groups（P〈0.05）. The visual analogue scale（VAS）, Oswestry disability index（ODI）, and Japanese Orthopedic Association（JOA） scores were used to evaluate the effectiveness; the area of intervertebral bone-graft, fusion rate, height of intervertebral space, and the number of Cage subsidence were measured by CT scan. Results All the patients were followed up 12.85 months on average（range, 9-15 months）. The VAS, ODI, and JOA scores were significantly improved at each time point after operation when compared with preoperative values（P〈0.05）, and no significant difference was found between 2 groups（P〈0.05） except VAS and ODI at 12 months after operation（P〈0.05）. However, the area of intervertebral bone-graft in reformative group [（5.94±1.17） cm2] was significantly larger than that in traditional group [（4.81±0.97） cm2] at 7 days after operation（t= —6.365, P=0.000）. At 3 and 12 months after operation, the fusion rate was respectively 84.2% and 92.1% in traditional group and was respectively 88.6% and 94.3% in reformative group. Although the height of intervertebral space were increased when compared with preoperative height, the incidence rates of Cages subsidence in traditional group were 44.74% and 47.37% respectively at 3 and 12 months after operation and were significantly higher those that in r

关 键 词：单侧经椎间孔椎体间融合术 椎间融合器 椎间隙高度 融合器下沉 

分 类 号：R687.3[医药卫生—骨科学]