斜向腰椎融合中不同型号椎间融合器与椎体终板损伤的关系  

Relationship between different types of interbody fusion cage and vertebral endplate injury in oblique lateral lumbar interbody fusion

作　　者：郑晓青[1] 尹东[1] 顾宏林[1] 梁国彦[1] 昌耘冰[1] Zheng Xiaoqing;Yin Dong;Gu Honglin;Liang Guoyan;Chang Yunbing(Guangdong Provincial People’s Hospital&Guangdong Academy of Medical Sciences,Guangzhou 510000,Guangdong Province,China)

机构地区：[1]广东省人民医院&广东省医学科学院

出　　处：《中国组织工程研究》2019年第34期5418-5424,共7页Chinese Journal of Tissue Engineering Research

基　　金：重大疾病防治科技行动计划创伤修复专项(2018ZX-01S-002)，项目名称：应用3D打印技术个体化精准治疗腰椎管狭窄症的临床研究，项目负责人：尹东~~

摘　　要：背景:在斜向椎间融合中,椎间融合器的骨接触面及植骨窗更大,维持椎间稳定性更强,下沉的风险更低,椎间融合率更高,在临床广受欢迎。目前还没有关于不同型号椎间融合器与术中椎体终板损伤的关系及对术后影像学影响的专门报道。目的:分析斜向腰椎椎间融合中融合器型号和椎体终板损伤的关系,以及对术后影像学疗效的影响,指导临床融合器型号的选择。方法:回顾分析2018年1月至2019年1月于广东省人民医院行单节段斜向腰椎融合的患者49例,所有患者对治疗方案均知情同意,且得到医院伦理委员会批准。收集患者影像学资料及临床资料,分析测量不同高度、宽度、长度椎间融合器和手术节段椎体终板损伤的关系;分析不同高度、宽度、长度椎间融合器对椎间隙高度、椎间隙后缘高度的作用,评估其影像学疗效;分析终板损伤对腰腿疼痛目测类比评分、Oswestry功能障碍指数的影响,评估其临床效果。结果与结论:①斜向腰椎融合术中出现终板损伤者所用椎间融合器高度显著高于无损伤者,提示融合器高度与终板损伤相关(P<0.05);②使用22 mm宽度融合器者比使用18 mm宽度者椎间隙后缘撑开更理想,提示融合器更宽术后影像学疗效更佳(P<0.05);③融合器的长度及宽度与术中终板损伤无明显相关性,差异无显著性意义(P>0.05);④融合器的高度、长度对椎间隙高度和椎间隙后缘撑开无明显影响,差异无显著性意义(P>0.05);⑤终板损伤对腰腿痛目测类比评分和Oswestry功能障碍指数无明显影响,差异无显著性意义(P>0.05);81.8%的终板损伤发生在下位椎体的上终板;⑥结果显示,融合器高度越高越容易终板损伤,且多见于上终板;宽度越大的融合器撑开椎间隙后缘更有优势。融合器的选择应重视高度及宽度2个重要参数。BACKGROUND:The characteristics of oblique lateral lumbar interbody fusion are large interbody fusion cage,large bone contact surface and large bone grafting window,leading to strong intervertebral stability,low risk of subsidence,and high intervertebral fusion rate.These advantages make this procedure popular in the clinic.At present,there is no specific report regarding the effects of the relationship between different types of interbody fusion cage and vertebral endplate injury in oblique lateral lumbar interbody fusion on postoperative imaging.OBJECTIVE:To investigate the relationship between different types of interbody fusion cage and vertebral endplate injury in oblique lateral lumbar interbody fusion as well as its effect on postoperative imaging,which can help select the model of clinical cages.METHODS:A retrospective analysis of 49 patients undergoing oblique lateral lumbar interbody fusion in a single segment from January 2018 to January 2019 was performed.All patients provided written informed consent and this study was approved by the Medical Ethics Committee of Guangdong Provincial People’s Hospital.Patient’s imaging data and clinical data were collected and the relationship between intervertebral cages of different heights,widths and lengths with vertebral endplate injuries of surgical segments was analyzed.The effects of intervertebral cages of different heights,widths and lengths on intervertebral space height and intervertebral posterior margin height were analyzed and the effects of the relationship on postoperative imaging were evaluated.The effects of endplate injury on Visual Analogue Scale and Oswestry Disability Index were analyzed,and the clinical effects were evaluated.RESULTS AND CONCLUSION:In the oblique lateral lumbar interbody fusion,the height of the interbody cage used in the endplate injury was significantly higher than that in the non-injured,suggesting that the height of the interbody cage was related to endplate injury(P<0.05).The 22 mm wide interbody cage was more ideal tha

关 键 词：终板损伤 椎间融合器 椎间隙后缘高度 椎间隙高度 宽度 高度 长度 椎间融合 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学]