异体腓骨环椎间融合器在腰椎融合术中的效果分析

Effect of allogeneic fibula ring fusion cage on lumbar degenerative diseases

目的探讨异体腓骨环椎间融合器(allogeneic fibula ring fusion cage,AFRFC)行腰椎融合的技术特点,并对照观察AFRFC与碳素纤维矩形椎间融合器(metacarbon fiber rectangle fusion cage,MFRFC)行经腰椎间孔入路腰椎椎间植骨融合术(transformamina lumbar interbody fusion,TLIF)手术治疗的临床疗效。方法回顾性总结西南医院骨科自2005年2月至2007年2月间收治的腰椎间盘突出症及术后复发、腰椎管狭窄、腰椎滑脱、腰椎不稳、腰椎间盘源性疼痛等需行椎间植骨融合的腰椎退行性病变患者91例,其中45例使用椎体间"品"字形植入3枚AFRFC,46例使用椎间植入单枚斜向MFRFC,通过术前、术后1周、术后3、6、12、24个月定期随访,复查腰椎CR或CT片测量其融合节段椎间隙高度、椎体矢状位移位及成角,并行下腰痛JOA评分,以及术中是否有神经根损伤、硬膜囊损伤、神经根牵拉伤等指标,量化评价手术治疗效果,并行对照研究。结果随访2～4年,平均随访时间AFRFC组35个月,MFRFC组36.8个月。术中神经根牵拉伤发生率,AFRFC组0%,MFRFC组8.7%,组间神经根牵拉伤发生率无统计学差异(χ2=2.29,P>0.05);术中所有病例均无神经根损伤、硬膜囊损伤;综合评价术后3个月融合率,AFRFC组为97.8%,MFRFC组为93.5%,组间各时间段对照,两组融合率无明显统计学差异(χ2=0.24,P>0.05);术后3个月椎间隙沉降率,AFRFC组0%,MFRFC组4.3%,组间沉降率对照有统计学差异(P<0.05);术前与术后3个月下腰痛JOA临床功能恢复情况评分恢复率,AFRFC组62.6%,MFRFC组67.4%,组间恢复率无统计学差异(P>0.05)。结论 AFRFC结合TLIF术式,可减少神经根牵拉伤的发生率、有效恢复椎间隙高度、防止椎间高度下沉,并提高术后融合率,是一种比较理想的椎间融合器。

Objective To study the characteristics of allogeneic fibula ring fusion cage （AFRFC） used in lumbar vertebral fusion and to compare the clinical outcome of transforlamina lumbar interbody fusion （TLIF） using AFRFC and metacarbon fiber rectangle fusion cage （MFRFC）. Methods Ninety-one patients with lumbar vertebra retrogression,lumbar intervertebral disc protrusion,palindromia,lumbar spinal stenosis,lumbar vertebra slippage and unsteadiness,and lumbar discogenic pain,who were treated with transforlamina lumbar interbody fusion at Department of Orthopedics,Southwest Hospital,Third Military Medical University （Chongqing,China） from February 2005 to February 2007,were retrospectively analyzed. Of these patients,45 were treated with 3 AFRFC implanted into the vertebra to form a triangle,46 were treated with MFRFC with one MFRFC obliquely implanted into the vertebra. The patients were followed up for 3,6,12,and 24 months after operation,during which lumbar vertebra CR or CT film was checked to measure the height of confusion segment in inter-vertebral space,the offset and angulation of the sagittal centrum,and the back pain JOA was scored. Other indicators,such as nerve root injury,meninx membranous sac damage,or nerve root tension injury,were quantitatively evaluated and control study was undertaken. Results The follow-up time was 2-4 years. The average follow-up time was 35 months for the patients treated with AFRFC and 36.8 months for the patients treated with MFRFC. The rate of tension injury at nerve root was 0% for the patients treated with AFRFC and 8.7% for the patients treated with MFRFC （Chi square=2.29,P 0.05）. No nerve root injury and meninx membranous sac damage occurred in all patients during operation. The fusion rate was 97.8% for the patients treated with AFRFC and 93.5 % for the patients treated with MFRFC three months after operation （Chi square=0.24,P 0.05）. The sedimentation rate in inter-vertebral space was 0% for the patients treated with AFRFC and 4.3% for the patients treated with MFRFC three months after operation （P0.05）. The low back function recovery rate was 62.6of for the patients treated with AFRFC and 67.4% for the patients treated with MFRFC three months after the operation （P 0.05）. Conclusion AFRFC is an ideal inter-vertebral fusion cage,which can effectively reduce the incidence of nerve root tension injury and restore the inter-vertebral space height.