摘要
背景：椎间融合器逐渐代替传统的椎体间自体结构植骨而广泛应用于腰椎后路椎间融合治疗中,但绝大多数报道此时均需辅以椎弓根螺钉系统内固定。目的：评估复发性腰椎间盘突出再次修复过程中单独应用扩张型椎间融合器行腰椎后路椎间融合而不需使用椎弓根螺钉辅助内固定的可行性。设计、时间及地点：回顾性病例分析,2004-10/2007-01在中山大学附属第三医院骨科进行。对象：对17例复发性腰椎间盘突出症患者采用可扩张椎间融合器行腰椎后路椎间融合再手术治疗,男7例,女10例,再次手术时年龄31-68岁,平均41岁,两次手术间隔时间9个月-8年,平均3.6年。17例均有持续或间歇性腰背痛,间歇性跛行5例、下肢反射痛9例、下肢麻木7例、下肢肌力减弱11例。方法：常规后路切口,保留棘突与棘间韧带,依次行双侧椎板减压,彻底减压,松解粘连,切除残留的椎间盘组织,撑开椎间隙,用绞刀、丝锥依次平行于终板绞孔与攻丝,自两侧旋入可扩张椎间融合器,确认位置正确后,旋拧位于融合器内的扩张螺丝、直至将椎间融合器完全扩张,于椎间融合器内置入自体松质骨碎骨块,最后将端盖轻轻拧紧。主要观察指标：手术时间、术中出血量;椎间融合器置入后与宿主的组织相容性反应;随访复查影像学表现、功能恢复情况。结果：①手术时间70-200min,平均90min,术中出血100-800mL,平均150mL。②17例均获得随访,随访时间6-32个月,平均18个月。均未发现椎间融合器移位、下沉,置入后4个月均开始出现骨性融合。无一例出现感染及置入物排斥反应。③置入后即刻下肢放射痛消失,下肢麻木症状于置入后2-6个月逐渐恢复。按Macnab法疗效评定标准随访结果为：优10例,良6例,可1例,优良率为94.1%。结论：腰椎间盘突出症再次修复过程中单独应用扩张型椎间融合器可以重建脊柱正常的生理序列。
BACKGROUND： Interbody fusion cage instead of traditional intervertebral bone allograft is gradually used in treating posterior interbody fusion. However, many reports are based on pedicle screw fixation system. OBJECTIVE： To evaluate surgical indication and results of reoperation by using profix cage alone for recurrent lumbar disc herniation. DESIGN, TIME AND SETTING： Retrospective case analysis was performed at Department of Orthopedics, Third Hospital of Sun Yet-sen University from October 2004 to January 2007. PARTICIPANTS： Seventeen cases with recurrent lumbar disc herniation underwent reoperation of posterior lumbar interbody fusion using profix cage alone, including 7 males and 10 females with an average age of 41 years （range 31 to 68 years）. The average interval between primary operation and reoperation was 3.6 years （range 9 months to 8 years）. All 17 patients complained of low back pain, and 5 had intermittent clandication, 9 had leg radicular pain, 7 had leg numbness and 11 had leg weakness. METHODS： Using routine posterior approach, spinal process and interspinal ligaments were retained. Bilateral vertebral plate decompression, complete decompression, and adhesion relaxing were performed, and remnant intervertebral disk tissue was removed. Intervertebral space was expanded, and expandable interbody infusion cage was tapped parallel to plate hole and thread tapping using rimer and tap, The screws were threaded until the cage was completely expanded. Autologous cancellous bone fragments were implanted in the cage, followed by hood cover. MAIN OUTCOME MEASURES： Surgery duration, blood loss, histocompatibility of the cage to host; imaging and functional recovery during follow up. RESULTS： Surgery was performed for 70-200 minutes with average time of 90 minutes; blood loss was 150 mL （range, 100-800 mL）. All 17 patients were followed-up for an average of 18 months （range 6 to 32 months）. During follow-up, the complications such as cage displacement and cage subsidence did not occur, however, the signs of bony fusion occurred in all patients till 4 months postoperatively. No infection or rejection reactions developed. Immediately after implantation, the radiating pain in the lower limbs disappeared, and numbness recovered 2-6 months postoperatively. According to the Macnab＇s criterion, the outcomes were excellent in 10 cases, good in 6 cases, and fair in 1 case; the excellent and good rate was 94.1%. CONCLUSION： It is effective to apply profix cage alone for recurrent lumbar disc herniation to rebuild the stability of lumbar.
出处
《中国组织工程研究与临床康复》
CAS
CSCD
北大核心
2008年第26期5015-5018,共4页
Journal of Clinical Rehabilitative Tissue Engineering Research
