可膨胀式椎间融合器在特殊腰椎退变手术中的应用

Application of Expandable Interbody Fusion Cage in the Special Degenerative Lumbar Spine Operation

目的:探讨可膨胀性椎间融合器治疗腰椎退行性疾病的效果。方法:2011年9月至2013年9月,采用可膨胀式椎间融合器手术治疗老年、肥胖的重度腰椎退变158例。回顾性分析其临床资料,对其治疗效果、椎间隙高度的变化、该融合器的优点、手术适应证的选择、特殊病例使用该融合器的意义等进行分析。结果:术后随访6-25个月,平均18个月。患者术前JOA评分平均5.5分,末次随访时JOA评分平均19分,术前、术后患者下腰痛评分差异有统计学意义(t=11.045,P<0.05),术后改善率优120例,良32例,可6例,术后优良率达到96%。术后3-6个月腰椎正侧位X线片可见椎间骨桥形成,平均融合时间为15周。术后随访3,6,9个月X线显示椎间高度无明显丢失。结论:可膨胀性椎间融合器用于治疗患有腰椎退行性疾病的老年、肥胖患者,具有创伤小、安全性高、融合率高、恢复良好等优点,具有很好的应用前景,值得进行临床推广应用。

Objective： To discuss the effect of the expandable interbody fusion cage used in lumbar de- generative disease. Methods： 158 aging and obese patients with severe lumbar degenerative had undergone the expandable intervertebral fusion cage surgery from September 2011 to September 2013. We analyzed retrospectively the clinic data of the patients＇ treatment effect, the change of the height of intervertebral space, the advantages of this fusion device, the operation indications and the significance of the special cases by using this fusion device. Results： The patients were followed up for 6 to 25 months, with an average of 18 months. From the data, we have got the results that the patients＇ average score was 5.5 in preoperative JOA. But the average score was up to 19 in the last follow-up visit. It had the statistical significance with the different scores in patients with low back pain before surgery and after surgery （t= 11. 045, P〈0.05）. In the 158 cases, 120 cases were excellent, 32 cases were good, 6 cases were qualified. The postoperative good rate was up to 96 percent. The intervertebral bone bridge formation was visible from lumbar positive lateral X ray three to six months after the operation, with 15 weeks of average conver- gence time. Patients were followed up for 3, 6, and 9 months, which showed no significant loss of intervertebral height in the X-rays. Conclusion： The expandable interbody fusion cage is a safe, high fusion rate and good recuperation surgical procedure to treat the elderly and obese patients who suffered from lumbar degenerative disease, it also has a good application prospect and worth for clinical application.