高度可调钛金材质融合器在脊柱内镜下腰椎融合中的应用  

Application of height adjustable titanium fusion cage in endoscopic lumbar fusion

作　　者：许伟[1] 李智斐[2] 万通 余伟波 张翼升 周劲衍[2] 卜献忠 钟远鸣[2] Xu Wei;Li Zhifei;Wan Tong;Yu Weibo;Zhang Yisheng;Zhou Jinyan;Bu Xianzhong;Zhong Yuanming(Guangxi University of Chinese Medicine,Nanning 530001,Guangxi Zhuang Autonomous Region,China;First Affiliated Hospital of Guangxi University of Chinese Medicine,Nanning 530023,Guangxi Zhuang Autonomous Region,China)

机构地区：[1]广西中医药大学,广西壮族自治区南宁市530001 [2]广西中医药大学第一附属医院,广西壮族自治区南宁市530023

出　　处：《中国组织工程研究》2022年第33期5335-5341,共7页Chinese Journal of Tissue Engineering Research

基　　金：国家自然科学基金项目(81760874),项目负责人:钟远鸣;广西重点研发计划项目(桂科AB20159018),项目负责人:钟远鸣;中医学广西一流学科项目(桂教科研[2018]12号),项目参与者:钟远鸣;广西研究生教育创新计划资助项目(YCBSZ2020001),项目负责人:许伟;广西研究生教育创新计划资助项目(YCBXJ2021009),项目负责人:卜献忠。

摘　　要：背景:经皮脊柱内镜下经椎间孔椎体融合是治疗腰椎退行性疾病的先进微创术式,传统的椎间融合器并不完全适用于微创术式,内镜下腰椎融合选择何种融合器仍存在争议。目的:探讨经皮脊柱内镜下置入高度可调钛金材质融合器进行椎间融合治疗腰椎退行性疾病的临床疗效。方法:回顾性分析2018年12月至2019年6月在广西中医药大学第一附属医院骨科行经皮脊柱内镜下腰椎融合的患者55例,根据所置入的融合器类型不同分为2组,撑开组(n=23)术中置入可撑开的高度可调钛金材质融合器,普通组(n=32)置入普通的腰椎融合器。记录两组患者术后并发症,比较两组患者治疗前后的腰椎JOA评分、目测类比评分、Oswestry功能障碍指数评分及影像学指标。结果与结论:①55例患者均获得12个月以上随访,均获得骨性融合,无内固定松动、断裂、融合器移位、沉降等并发症发生;②与治疗前比较,两组患者治疗后2周、3个月、6个月、12个月的腰痛与腿痛目测类比评分、腰椎JOA评分、Oswestry功能障碍指数均有明显改善(P<0.05);撑开组治疗后12个月的腰椎JOA评分及治疗后6,12个月的Oswestry功能障碍指数均优于普通组(P<0.05);③与治疗前比较,两组患者治疗后的椎间隙高度、融合节段椎间孔高度、手术节段前凸角及腰椎前凸角均有明显改善(P<0.05);撑开组治疗后5 d、12个月的椎间隙高度、融合节段椎间孔高度、手术节段前凸角及腰椎前凸角优于普通组(P<0.05);④结果表明,经皮脊柱内镜下腰椎融合是治疗腰椎退行性疾病较为可靠的微创术式,联合置入高度可调钛金材质融合器可提高临床疗效。BACKGROUND:Percutaneous endoscopic interbody foraminal interbody fusion is an advanced minimally invasive method for the treatment of lumbar degenerative diseases.The traditional interbody fusion cage is not fully suitable for minimally invasive surgery.The choice of fusion cage for endoscopic lumbar fusion is still controversial.OBJECTIVE:To explore the clinical effect of percutaneous spinal endoscopic implantation of height adjustable titanium fusion cage for interbody fusion in the treatment of lumbar degenerative diseases.METHODS:A retrospective study investigated 55 patients who underwent percutaneous endoscopic lumbar fusion in the Department of Orthopedics of First Affiliated Hospital of Guangxi University of Chinese Medicine from December 2018 to June 2019.According to the different types of fusion cages implanted,they were divided into two groups.The stretch group(n=23)was implanted with a retractable height adjustable titanium fusion cage,and the general group(n=32)was used with an ordinary lumbar fusion cage.Postoperative complications were recorded in the two groups.The JOA score,Visual Analogue Scale score,and Oswestry Disability Index in the two groups were compared before and after treatment.This study was approved by the Ethics Committee of the First Affiliated Hospital of Guangxi University of Chinese Medicine.RESULTS AND CONCLUSION:(1)All 55 patients were followed-up for more than 12 months.All patients obtained bony fusion without complications,such as internal fixation loosening,fracture,fusion cage displacement,or settlement.(2)Compared with those before treatment,Visual Analogue Scale scores of low back pain and leg pain,JOA score,and Oswestry Disability Index were significantly improved in the two groups at 2 weeks,3,6,and 12 months after operation(P<0.05).JOA score at 12 months and Oswestry Disability Index at 6 and 12 months were significantly better in the stretch group than those in the general group(P<0.05).(3)Compared with those before treatment,the height of the intervertebral space,

关 键 词：腰椎退行性疾病 高度可调融合器 脊柱内镜 椎间融合 微创手术 椎间隙高度 腰椎前凸角 

分 类 号：R459.9[医药卫生—治疗学] R687.3[医药卫生—临床医学]