摘要
目的 探讨临床上腰椎前路术中相邻椎体局部取骨的可行性、安全性及优缺点。方法 对20例患者进行了单节段或多节段的360^。腰椎融合术（前路椎间融合器融合、后路椎弓根螺钉内固定及横突问植骨）。相邻椎体取骨，空腔由柱状三磷酸钙（TCP）填塞，取出的椎体松质骨填人椎问融合器。术前、术后即刻及最终随访时分别拍摄x线片，测量椎间隙前后缘高度、椎间隙角度及椎体高度。最终随访时所有病例均拍摄过伸过屈位x线片。同时统计了术中和术后出血量、手术时间、并发症以及视觉疼痛评分（VAS）和Oswestry伤残评分（ODI）情况。结果 20例患者中成功椎体取骨28个，无血管损伤，前路手术出血量平均250ml（50～350ml）。2例手术操作不当，但未影响临床疗效：1例植入柱状TCP时发生断裂，1例终板骨折。平均随访28个月（12～38个月），所有病例均获融合，VAS和ODI评分均较术前显著改善（P〈O．01）。结论 相邻椎体柱状取骨安全有效；柱状TCP填充空腔后仍可使用后路椎弓根内固定。
Objective Harvest of autogenous bone from lilac crest has long been held as the gold standard for anterior lumbar arthrodesis. This technique is accompanied by an added morbidity to the pelvis. The present study was to validate the experimental result showing that harvesting bone tissue from an adjacent vertebral body for bone graft followed by replacing the defect by β-tricalcium phosphate （TCP） plug could be a feasible procedure in lumbar interbody fusion procedure. Methods 20 patients underwent single- or multiple-level circumferential lumbar fusion with anterior cages and posterior pedicle screws in one institution. All cages were filled with cancellous bone harvested from the adjacent vertebral body, with the resulted vertebral body defect filled with a TCP plug. Results Bone grafts were successfully harvested from 28 vertebral bodies in all the patients There was no major vascular injury, and blood loss of the anterior procedure averaged 250ml （50-350ml）. One TCP plug was broken during its insertion, and one endplate was broken, both due to wrong surgical technique. These incidences did not affect the final outcome. At the last follow up （mean 28 months）, a solid lumbar spine fusion was demonstrated in all the patients. At 2-year follow up, ODI and VAS were remarkably improved （P〈0. 01 ）. Conclusion The data in this study suggest that harvesting a cylinder of autograft from the adjacent vertebral body is safe and efficient. Filling of the bone defect with a β-tricalcium phosphate plug does not preclude the use of posterior pedicle screw stabilization.
出处
《解放军医学杂志》
CAS
CSCD
北大核心
2006年第3期207-209,共3页
Medical Journal of Chinese People's Liberation Army
关键词
脊柱融合术
腰椎
三磷酸钙
内固定器
spinal fusion
lumbar vertebrea
tricalcium phosphate
internal fixators
