同种异体骨Cage在经椎间孔腰椎椎间融合手术中的应用

Clinical outcomes of allograft Cages in transforaminal lumbar interbody fusion

目的评估同种异体骨Cage在经椎间孔腰椎椎间融合术(transforaminal lumbar interbody fusion,TLIF)术后的融合效果。方法回顾分析2015年1月—2017年1月使用同种异体骨Cage行TLIF的30例患者(38个节段)临床资料。男25例,女5例;年龄44～72岁,平均56.9岁。腰椎间盘突出症20例,腰椎滑脱7例,腰椎管狭窄3例。手术节段:单节段22例,L_(3、4) 4例,L_(4、5) 13例,L5、S1 5例;双节段8例,L_(4、5)～L5、S1 6例,L_(3、4)～L_(4、5)2例。病程6～36个月,平均12个月。术前,术后3、6个月及末次随访时采用疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)和日本骨科协会(JOA)评分评估临床疗效;术后3、6个月摄正侧位X线片及行CT三维重建评估融合率;术前及术后3 d、3个月、6个月分别摄腰椎正侧位X线片测量椎间隙高度。结果手术时间2.1～4.3 h,平均3.1 h;术中出血量150～820 mL,平均407.5 mL。30例均获随访,随访时间8～25个月,平均16.4个月。1例术后6个月出现Cage下缘碎裂,不伴Cage移动,无神经症状;其余患者均无Cage脱出、位移、碎裂等情况发生。所有患者均无局部或全身变态反应或感染征象,随访期间无神经压迫、受损症状。30例患者术后各时间点VAS评分、ODI评分及JOA评分均较术前显著改善(P<0.05);术后6个月及末次随访时显著优于术后3个月(P<0.05);术后6个月和末次随访间比较差异无统计学意义(P>0.05)。X线片及CT三维重建示,术后3、6个月及末次随访时的融合率分别为55.3%(21/38)、92.1%(35/38)、100%(38/38)。术后3 d、3个月、6个月及末次随访时椎间隙高度均较术前显著改善(P<0.05);末次随访时与术后3 d比较椎间隙高度有所丢失,差异有统计学意义(P<0.05)。结论同种异体骨Cage在腰椎TLIF术后可提供早期稳定性和较高融合率。

Objective To explore the fusion effect of allograft Cages on transforaminal lumbar interbody fusion（TLIF）. Methods The clinical data of 30 patients（38 vertebral segments） who underwent TLIF with allograft interbody fusion Cages between January 2015 and January 2017 were retrospectively analysed. There were 25 males and 5 females with an average age of 56.9 years（range, 44-72 years）. The lesions included 20 cases of lumbar disc herniation, 7 cases of lumbar spondylolisthesis, and 3 cases of lumbar spinal stenosis. The operation section included 4 cases of L3, 4, 13 cases of L4, 5, 5 cases of L5, S1, 6 cases of L4, 5-L5, S1, and 2 cases of L3, 4-L4, 5. The disease duration was 6-36 months（mean, 12 months）.The clinical effectiveness was evaluated by visual analogue scale（VAS） score, Oswestry disability index（ODI）, and Japanese Orthopaedic Association（JOA） score at preoperation, 3 months and 6 months after operation, and last followup. The fusion rate was evaluated by anteroposterior and lateral X-ray films and CT three-dimensional reconstruction at3 and 6 months after operation. The intervertebral space height was measured on anteroposterior and lateral X-ray films at preoperation, 3 days, 3 months, and 6 months after operation. Results The operation time was 2.1-4.3 hours（mean,3.1 hours）, and the intraoperative blood loss was 150-820 mL（mean, 407.5 mL）. The follow-up time was 8-25 months（mean, 16.4 months）. One Cage split at 6 months after operation without Cage movement and neurologic symptoms;none of the other patients had Cage prolapse, displacement, and fragmentation. No local or systemic allergy or infection signs was found in all patients. No nerve compression or symptoms was observed during the follow-up. The postoperative VAS score, ODI score, and JOA score improved significantly when compared with preoperative scores（P〈0.05）; and the scores at 6 months and at last follow-up were significantly improved when compared with those at 3 months after operation（P〈0.05）; but no significant difference was found between at 6 months and at last follow-up（P〉0.05）. The fusion rate was 55.3%（21/38）, 92.1%（35/38）, and 100%（38/38） at 3 months, 6 months, and last follow-up postoperatively.The intervertebral space height was increased significantly at 3 days, 3 months, 6 months, and last follow-up postoperatively when compared with preoperative ones（P〈0.05）; and the loss of intervertebral space height was significant at last follow-up when compared with postoperative at 3 days（P〈0.05）. Conclusion The allograft interbody fusion Cage contributes to the spine interbody fusion by providing an earlier stability and higher fusion rate.