后路椎间融合钉棒系统内固定在腰椎椎间盘突出症术后复发中的应用

Posterior interbody fusion combined with intervertebral fixation in treatment of postoperative recurrence of lumbar disc herniation

目的探讨腰椎椎间盘突出症术后复发再次手术中应用椎间融合器后路置入并椎弓根螺钉系统的适应证及疗效。方法2005年12月～2008年12月,应用后路椎间融合器(PLIF)并椎弓根螺钉系统治疗术后复发的腰椎椎间盘突出症患者12例,其中10例为同侧复发,2例为对侧复发。应用单侧椎弓根钉棒系统并单枚斜向椎间融合器治疗4例,双侧钉棒系统并双融合器治疗8例,根据手术前后的X线片、CT检查和JOA评分,判定该术式的融合率和临床效果。结果随访8～24个月,平均16个月,经X线及CT检查,融合率为96.2%;按JOA评分计算的术后综合平均改善率为91.5%。结论在腰椎椎间盘突出症术后复发再次手术中应用后路椎间融合器(PLIF)并椎弓根螺钉系统能尽可能多地保留脊柱后部结构,增加了融合术后的椎节即刻稳定性,恢复和维持椎间高度,取得了高融合率和高综合改善率的双重效果。其中单侧固定单枚融合器疗效具有创伤少的优点,与双侧固定双枚融合器疗效相当,但需严格掌握手术指征。

Objective To investigate the indications and the efficacy of the posterior interbody fusion combined with intervertebral fixation in treatment of postoperative recurrence of lumbar disc herniation.Methods From December 2005 to December 2008,posterior interbody fusion combined with intervertebral fixation were performed in 12 patients with postoperative recurrence of lumbar disc herniation,in whom 10 cases of ipsilateral recurrence and 2 cases of contralateral recurrence.In all 12 cases,4 patients were treated with unilateral pedicle screw-rod system and single diagonal interbody fusion,while 8 patients with bilateral screw-rod system and dual-fusion.The fusion rate and clinical efficacy were evaluated according to postoperative X-rays,CT and JOA score.Results The period of follow-up ranged from 8 to 24 months with an average time of 16 months.The fusion rate was 96.2% according to the postoperative X-rays and CT examination.The postoperative improvement rate of JOA score was 91.5%.Conclusion In the treatment of patients with postoperative recurrence of lumbar disc herniation,posterior interbody fusion combined with intervertebral fixation can retain the rear of the structure of the vetebrae as much as possible,increase the initial stability after fusion,restore and maintain the intervertebral height,and elevate both the fusion rate and the improvement rate.The treatment of unilateral pedicle screw-rod system and single diagonal interbody fusion with less trauma can obtain nearly equivalent efficacy as the treatment of bilateral screw-rod system and dual-fusion,but the surgical indications must be obedienced strictly.