X-Tube下后路腰椎间融合治疗腰椎退变性疾病

Treatment of lumbar degenerative disease with intervertebral cage through the X-Tube system

目的:探讨X-Tube下后路椎间螺纹状cage置入加植骨融合治疗腰椎退变性疾病的可行性及疗效。方法:2004年6月～2006年2月在X-Tube下行后路椎间螺纹状cage置入加植骨融合治疗33例患者,男18例,女15例。腰椎间盘突出症17例;腰椎Ⅰ度滑脱3例;腰椎管狭窄症11例;椎间盘源性腰痛2例。术前、术后及末次随访时采用ODI及VAS评估患者功能,在X线片上观察患者椎间隙高度及植骨融合情况。结果:术中发生硬脊膜损伤2例,其中1例术中应用明胶海绵及生物蛋白胶封堵硬膜,术后出现低热,应用抗生素2周后症状消失;另1例术中行硬脊膜修补,术后未出现脑脊液漏及神经损伤症状。失访3例,30例患者随访6～22个月,平均14.4个月,ODI评分术前为39.64±2.72分;术后1个月及末次随访时分别为17.58±3.29分和4.50±1.60分,与术前比较均有显著性差异(P<0.01)。VAS评分术前为8.17±0.79分;术后1个月及末次随访时分别为4.67±0.78分和1.54±0.90分,与术前比较均有显著性差异(P<0.01)。椎间隙高度术前为8.97±0.81mm,术后1个月及末次随访时分别为14.53±0.57mm和12.79±0.91mm,与术前比较均有显著性差异(P<0.01)。1例患者术后11个月时影像学检查未见骨融合,余29例患者均获椎体间植骨融合,未见cage移位或脱出。结论:X-Tube下行后路椎体间cage置入植骨融合治疗腰椎退变性疾病可取得满意效果,是可供选择的微创治疗方法之一。

Objective：To study the feasibility and the effect of using the minimal invasive fusion technique with the intervertebral threaded cage under the X-Tube system for the lumbar degenerative disease.Method： From June 2004 to February 2006,33 cases were treated with minimal invasive cage fusion technique under X-Tube,which included 18 males and 15 females.There were 17 cases with lumbar disc herniation,3 cases with spondylolisthesis （grade Ⅰ ）,11 cases with lumbar spinal stenosis,2 cases with discogenic pain.The preoperative,Ⅰ month postoperative and latest follow-up functional evaluation were graded with ODI and VAS scoring system.The height of the intervertebral space and the fusion status were measured as well.Result：Dural tear happened in 2 cases,glutin sponge and biological glue were used in one case for dural tear sealing, while the patient got a low fever after surgery and healed with antibiotics in 2 weeks after surgery.Dural sac suturing was performed in another case.Neither cerebrospinal fluid leaking nor neurological injury was found. 3 cases lost follow up,and the average follow-up time was 14.4 mouths.The preoperative,1 month postoperative and latest follow-up ODI scores were 39.64±2.72,17.58±3.29 and 4.50±1.60 separately,while the corresponding VAS scores were 8.17±0.70,4.67±0.78 and 1.54±0.90 （P〈0.01）.The preoperative,1 month postoperative and latest follow-up measuring of the height of intervertebrae space were 8.97±0.81mm,14.53±0.75mm and 12.79±0.91mm（P〈0.01）.Non-fusion only happened in one case at 11 months follow up, the other 29 cases achieved solid bony fusion.No cage shift or escape was noticed.Conclusion：Minimal invasive lumbar intervertebral cage fusion technique could achieve satisfactory clinical results.