下腰椎单节段TFC椎间融合术后影像学改变

Radiological image change after using threaded fusion cage for single segment interbody fusion

目的 了解下腰椎单节段应用Ray -TFC不附加内固定治疗腰椎间盘病变及腰椎不稳症术后影像学改变。方法 以我院应用Ray -TFC不附加内固定治疗腰椎间盘病变及腰椎不稳症 ,术后随访超过两年的 5 0例患者为研究对象。取上述 5 0例患者术前、术后两周、术后两年侧位X线片 ,分别测量病变节段前凸角度、椎间隙中央高度 ,观察椎间融合情况、融合器位置变化、相邻椎间隙退变情况 ,并对上述结果进行分析。结果 本组均为单节段椎间融合 ,腰4～ 5节段病变 3 9例 ,腰5骶1节段病变 11例。术前病变节段前凸角度平均 16 4度 ,术后两周 15 9度 ,术后两年 15 2度。 47例 (94% )前凸角度的变化小于 3度。术前病变节段椎间隙中央高度平均 7 6mm ,术后两周 10 1mm ,平均撑开高度 2 5mm。术后两年椎间高度平均 9 3mm ,丢失小于 1mm。TFC植入深度 ,TFC后缘距椎体后缘平均 3 2mm。术后两年X片见到直接骨融合征象者 14例 ,临床骨融合征象者 3 4例 ,TFC周边见到透亮区者 1例 ,TFC位置变化 3例 ,其中 2例侧位片动力位像稳定。椎间融合成功率 96%。病变节段上位椎间隙退变加速 2例。结论 ①下腰椎单节段植入一对Ray -TFC对腰椎生理前凸无明显影响。②TFC植入对撑开病变间隙和维持术后椎间高度有重要意义 ,平均撑开高度 2

Objectives To determine radiological image change after the Ray Threaded Fusion Cage alone for lumber disc disease or lumber instability of single segment Methods We selected 50 patients with lumber disc disease or lumber instability of single segment for the study team , who were operated with the Ray Threaded Fusion Cage alone and were followed up for two years The study team include 39 L4,5 segment and 11 L5S1 segment Using their lateral radiograph of prior-operation , two weeks and two years after operation , We measured the salient of affacted segment and center height of disc and observed the state of the lumber fusion,the TFC position and the adjacent segment degeneration Results (1) The mean salient of prior-operation , two weeks and two years after operation is 16 4 ,15 9 and 15 2 degree The salient variety of 47 patients (94%) was less than 3 degree (2) The mean center disc height of two weeks after operation is 2 5mm higher than prior-operation and 1mm higher than two years ( prior-operation,7 6 mm; two weeks after operation,10 1 mm; two years after operation, 9 3 mm) (3) The mean distance between TFC rear and cone rear (the depth of TFC) is 3 2 mm Three patients appeared the variety of TFC position, only one patients appeared lumber instability (4) According the lateral radiograph of two years after operation, 14 patients appeared radiographic and clinical cone fusion , 34 patients appeared clinical cone fusion, only one patient appeared transparent belt around TFC The probability of fusion is 96% (5) Two patients appeared the accelerated upper segment degeneration Conclusions (1) the Ray TFC for lumber single segment has no obviously effect to physiological curve (2) TFC is of important significance to keeping the height of disc (3) The probability of fusion is 96% at two years after operation (4) The depth of TFC has better exceed 3 mm (5) After cone fusion , The adjacent segment degeneration is slight in short time