单节段腰椎融合术中融合器对腰椎前凸角的影响

Effect of the Cage on Lumbar Lordosis in Single-segment Lumbar Interbody Fusion Operation

目的:探讨单节段经椎间孔入路椎间融合术(TLIF)手术中,椎间融合器(Cage)的位置和大小对融合术后腰椎前凸角(LL)恢复程度及临床疗效的影响。方法:回顾性分析57例因腰椎退行性疾病行L4~5或L5S1单节段TLIF手术的患者。通过腰椎正侧位片测量Cage的中心点比(CPR)、后间隙比(PGR)、椎间隙高度(DH)、手术前后DH变化(ΔDH)、手术节段间前凸角(SLL)、腰椎前凸角。CPR和PGR代表Cage的位置参数,ΔDH为Cage的大小参数。对术后Cage位置、大小参数与SLL和LL差值及临床指标改善值进行相关性分析。结果:全组患者VAS评分、JOA评分、SLL,LL,DH均较术前明显改善,差异均有统计学意义(P<0.05)。CPR和PGR与SLL变化密切正相关(r=0.63,r=0.60,P<0.01),CPR和PGR与LL变化也表现出密切正相关(r=0.39,r=0.39,P<0.01),而ΔDH与SLL和LL变化表现为负相关(r=-0.58,r=-0.37,P<0.01)。SLL和LL变化与JOA评分改善之间具有相关性(r=0.38,r=0.65,P<0.05),与VAS评分未见明显相关性。结论:在TLIF手术中使Cage适当稍前放置及选用适中大小的Cage可以一定程度改善腰椎前凸,并且提高患者的JOA功能评分。

Objective:To investigate the effect of position and size of the cage on the recovery and clinical efficacy of lumbar lordosis(LL) in the single-segment transforaminal lumbar interbody fusion(TLIF) operation.Methods:57 patients who underwent L4/5 or L5/S1 single-segment TLIF surgery for degenerative lumbar disease were retrospectively analyzed.Cage central point ratio(CPR),posterior gap ratio(PGR),disc height(DH),DH change before and after operation to ΔDH,surgical section segment lumbar lordosis(SLL),lumbar lordosis were measured by lumbar anterolateral radiograph, CPR and PGR represent the position parameters of cage, and ΔDH is the size parameter of cage.The correlation of postoperative cage position, size parameters and SLL,LL difference and clinical index improvement value was analyzed.Results:The VAS score, JOA score, SLL, LL, and DH of all patients were significantly improved compared with those before operation, and the differences were statistically significant(P<0.05).CPR, PGR and SLL changes were closely and positively correlated(r=0.63, r=0.60, P<0.01).CPR, PGR and LL changes also showed a close positive correlation(r=0.39, r=0.39, P<0.01), and ΔDH was negatively correlated with changes in SLL and LL(r=-0.58, r=-0.37, P<0.01).There was a correlation between the changes of SLL, LL and the improvement of JOA score(r=0.38, r=0.65, P<0.05), but no significant correlation with VAS.Conclusion:In the TLIF operation, cage placed a little bit ahead and choosing a moderate size cage can improve lumbar lordosis to a certain extent, and improve the patient’s JOA score.