单枚与双枚椎间融合器治疗退行性腰椎不稳症疗效比较

Clinical control study in treating degenerative lumbar instability with T-PLUS or double cages

目的比较植入单枚T—PLUS椎间融合器与传统双枚椎间融合器（cage）治疗退行性腰椎不稳症的疗效。方法2008年1月至2011年12月．27例有双下肢神经症状的退行性腰椎不稳症患者。其中男14例，女13例；年龄45-67岁，平均53-＋3．2岁。随机分为两组，均采用椎间孔入路（Transforaminallumbarinterbodyfusion，TLIF）分别植入单枚T-PLUS融合器（A组，n=12）和传统双枚cage（B组，n=15）结合椎弓根螺钉系统．进行减压、复位、内固定、椎体间植骨融合等治疗。27例均获随访，时间8-22个月，平均15±2．5个月。术后分别比较手术操作时间、术中失血量及术后植骨融合率、椎间隙高度变化等，并进行下腰疼JOA评分。结果A组中1例于术后第2天开始出现下肢放射痛，1周后症状逐渐缓解。2组患者植骨融合率、椎间高度丢失、JOA评分均无统计学差异（P〉0．05），而手术操作时间、术中失血量方面有统计学差异（P〈0．05）．结论应用TLIF手术治疗腰椎不稳植入单枚T—PLUS操作简单、失血量少、费用低廉，植骨融合率及椎间隙高度恢复优于双侧植入cage。

Objective To compare the clinical and radiologic effect in treating degenerative lumbar instability with T-PLUS or double cages. Methods From Jan 2008 to Dec 2011, 27 patients of degenerative lumbar instability, including 14 males and 13 females with the age 45-67 years, average of 53±3.2 years, were underwent pedicle screw fixation. 12 cases, named T-PLUS group, were applied with single T-PLUS cage. The other 15 cases, as control group, were treated with two cages. And all cases were followed up 15±2.5 months. The clinical effect, intervertebral fusion ratio and lost intervertebral height were compared between two groups. The JOA evaluation were observed. Results There was no significant difference be- tween two groups in intervertebral fusion ratio, lost intervertebral height and JOA evalution （P〉0.05）, although significant difference was showed be- tween two groups in operating time and bleeding. Conclusion T-PLUS cage in treating degenerative lumbar instability can obtain satisfactory cu- rative effect as same as double cages. T-PLUS cage has advantages such as minimally trauma, simply operation, cheaply price than double cages.