ProSpace在腰椎固定中的作用

Effect of ProSpace for the lumbar internal fixation

目的通过对ProSpace加腰椎椎弓根钉固定术后病人随访,探讨ProSpace在腰椎固定中的作用。方法ProSpace加椎弓根钉固定腰椎手术病人41例,男21例,女20例,平均57.5岁,手术部位L3、43例,L4、527例,L5S19例,L4、5、L5S1同时固定2例。测量所有病人术前、术后一周及复查时的X线片侧位片,记录间盘间隙中点连线高度与上一椎体中点连线高度的比值,并行CT扫描观察椎体间融合情况。结果41例病人随访37例,占90.2%。平均随访时间14.5个月。按照Yuan术后评价标准,37例病人中神经功能改善95%(35/37),无改善5%(2/37);脊柱活动改善97%(36/37),无改善3%(1/37);腰背痛改善92%(34/37),无改善5%(2/35),加重3%(1/37);下肢疼痛改善95%(35/37),无改善5%(2/37)。其中假体滑脱2例2个。X线片测量结果显示术前与术后、复查时的结果比较间盘高度有明显差异(P<0.001),术后与复查时的结果比较无明显差异(P>0.05)。CT扫描结果显示在终板之间有“等密度”影像出现,提示椎间的骨性融合。结论后路椎弓根钉固定加椎体间ProSpace的植入,能够最大限度的增加假体与椎体终板的接触,减少术后椎间隙的塌陷可能。达到脊柱三维融合的目的。

Objective:To discuss the effect of ProSpace in lumbar internal fixation by following up the patients treated with lumbar pedicle screw combined ProSpace. Method:Forty-one patients (male 21,female 20)were converged in this study with mean age of 57.5 years.The operation segment in L_~3、4 included 3 cases,27 cases in L_~4、5 ,9 cases in L_5S_1 and there were 2 cases encountered operation in both L_~4、5 and L_5S_1.The lateral X-ray of all patients in pre-operation,one week after operation and reexamination were measured and the ratio of the height between the disc midpoint and that between adjacent vertebral midpoint was recorded.CT scan was performed to evaluate the fusion between vertebrae.Result: Of the 41 cases,37 cases (90.2%) was followed up with an average of 14.5 months.According to the evaluation standard of Yuan,nerve function improvement was in 35 cases accounted for 95% (35/37),5% had no improvement (2/37);97% patients had improvement in movement of spine(36/37) ,no improvement was accounted for 3%(1/37);back pain relief was occurrence in 92% patients(34/37),no relief was 5%(2/37)and the aggravated accounted for 3%(1/37);95% patients had relieve in pain of legs(35/37),5% had no relief (2/37).Graft slippage occurrence in 2 cases.X-ray showed that there was significant difference between pre-operation,post-operation and reexamination (P<0.001) and no significant difference between post-operation and reexamination(P>0.05).The CT scan showed there were “isodense” image between graft and the end plate which means bone fusion occurrence at inter vertebrae.Conclusion:The implantation of ProSpace is easy and safe in manipulation,it increases the contact area between the graft and end plate as much as possible and reduces the occurrence rate of inter vertebral collapse after operation.Posterior pedicle screw internal fixation with additional ProSpace imoplantation at inter vertebral can provid more strong stabilization of spine which achieves three dimensions fusion consequence so could make a progress in clinical effects.