单枚融合器椎体间融合治疗腰椎退变性侧弯

Lumbar interbody fusion using a unilateral single cage in the treatment of degenerative lumbar scoliosis

目的了解长节段固定配合凹侧单枚融合器植入技术治疗腰椎退变性侧弯的临床疗效及围手术期并发症。方法选取我院2005年1月至2011年12月住院因腰椎退变性侧弯行腰椎后路椎体间融合手术患者70例,其中男33例,女37例,年龄46～76岁(平均62岁),所有患者采用椎弓根螺钉联合椎间融合,椎弓根螺钉选用Mossmiami(Johnson&Johnson,USA)、XIAⅡ(Stryker,USA)及TSRH(Medtronic Sofamor Danek,USA),融合器选用AVS PL(Stryker,USA)、Capstone(Medtronic Sofamor Danek,USA),随访12-36个月(平均20个月)。对所有病例进行定期随访和影像学检查观测,其指标包括:手术前后腰椎正侧位片、屈伸侧位片、腰椎MRI片、腰椎Cobb's角变化,椎间稳定性变化、临床Oswestry功能障碍指数评估、VAS疼痛指数,围手术期和远期并发症情况。结果长节段固定配合凹侧单枚融合器植入术前、术后患者腰椎Cobb's角度变化有明显统计学差异,至末次随访时所有患者均未出现融合器移位及内固定器械松动或断裂。ODI指数及VAS疼痛评分术后与术前相比有明显统计学差异。结论长节段固定配合凹侧单枚融合器植入技术能够减少手术费用,减少手术时间及出血量,是一种较为理想的融合治疗腰椎退变性侧弯技术。

Objective To evaluate the clinical effect and perioperative complications of long segment fixation with single cage implantation on the concave side for patient with degenerative lumbar scoliosis. Methods 70 patients with degenerative lumbar scoliosis were treated by posterior lumbar interbody fusion in our hospital from January 2005 to December 2011. Among them, there were 33 males and 37 females, whose average age was 62.0 years old （range; 46-67 years）. All patients were treated with pedicle screws combined with interbody fusion. Pedicle screw selection included Mossmiami （Johnson ＆ Johnson, USA）, XIA II （Stryker, USA） and TSRH （Medtronic Sofamor Danek, USA）. Cage selection included AVS PL （Stryker, USA） and Capstone （Medtronic Sofamor Danek, USA）. All patients were followed up for an average period of 20 months （range; 12-36 months）. Regular follow-up and radiographic examinations were performed for all patients, including anteroposterior and lateral X-rays, flexion-extension X-rays and MRI of the lumbar spine, lumbar Cobb angle changes, changes in intervertebral stability, clinical Oswestry Disability Index （ODI）, Visual Analogue Scale （VAS） pain scores, and perioperative and long-term complications before and after surgery. Results There were statistically significant differences in lumbar Cobb angle before and after long segment fixation with single cage implantation on the concave side. No cage malposition or loosening or breakage of internal fixation devices was observed until the latest follow-up. There were statistically significant differences in ODI and VAS pain scores before and after surgery. Conclusions Long segment fixation with single cage implantation on the concave side is a satisfactory fusion treatment method for patients with degenerative lumbar scoliosis, with the advantages of less surgery cost, shorter operation time and less blood loss.