后路腰椎椎间融合器的优化设计

Optimization design of posterior lumbar interbody fusion cage

背景:后路椎间融合器是治疗脊柱椎间盘病变的主要手段之一。应用后路椎间融合器除因为适应证选取及手术操作不当等原因外常常会因为设计上的不合理而引发融合器沉陷、移位等并发症。目的:通过回顾脊柱融合器的产生、发展和其他学者对后路椎间融合器应用的生物力学环境的研究对融合器进行优化设计。方法:以"后路椎间融合器,沉陷,设计,植骨融合,生物力学"为检索词,应用计算机检索中国知网全文数据库1990年1月至2012年2月有关文章。纳入后路椎间融合器的优化设计有关的文献。排除与研究目的无关和内容重复者。保留18篇文献同时查阅《现代脊柱外科学》《脊柱内固定手术学》等相关专著做进一步分析。结果与结论:后路椎间融合器经过优化设计后,终板后外侧较高的强度可以保证融合器植入椎间后防止融合器陷入椎体,同时又显著增加了融合面的面积,进一步降低应力遮挡,可以提高融合率,加速融合进程,减少沉陷、移位等并发症的产生,获得满意的临床效果。

BACKGROUND： Posterior lumbar interbody fusion cage is one of the main means for the treatment of disc disease. The application of posterior lumbar interbody fusion can cause cage subsidence and other complications due to improper design, besides improper indication selection and improper surgical operation. OBJECTIVE： To optimize the cage design by reviewing the development of cage and concluding the other scholars＇ biomechanical research on the application of posterior lumbar interbody fusion cage.METHODS： A computer-based searched was performed in CNKI full-text database for the articles on optimize design of posterior lumbar interbody fusion cage from January 1990 to February 2012. The key words were ＂posterior lumbar interbody fusion cage, sinkage, design, bone graft fusion, biomechanicar＂. The literatures of irrelevant purpose and repetitive content were eliminated, and then 18 literatures were included and checked the Modern Spine Surgery and Spinal Internal Fixation Operation and other related books for further analysis.RESULTS AND CONCLUSION： After optimization, the cage implanted in the interbody could acquire sufficient strength, which can support the end-plate and prevent cage from the early subsiding within the vertebral body. At the same time, the optimization can greatly increase the fusion area, further reduce the stress shielding, improve the fusion rate, accelerate the fusion process, reduce the subsidence, displacement and other complications, and all this will get a satisfactory clinical effect.