腰椎滑脱组合式椎间处理器辅助椎体间融合术

Lumbar interbody fusion with self-developed intervertebral space processing instrument set and spinous process-lamina-facet block graft for isthmic spondylolisthesis

[目的]介绍应用组合式椎间处理器并自体棘突椎板关节突骨块的椎间融合技术治疗峡部裂型腰椎滑脱症的手术技术与初步临床疗效。[方法] 2014年1月~2019年1月,对157例峡部裂型腰椎滑脱症患者应用组合式椎间处理器并自体棘突、椎板关节突骨块的椎间融合技术治疗。术中将腰椎峡部裂节段的棘突椎板关节突骨块完整切除备用,应用自行设计的"组合式椎间处理器"螺纹化处理椎间隙上下终板,将完整剥离的棘突椎板关节突骨块,根据目标间隙椎间高度修整成类似融合器外观,行椎间打压植骨融合,椎弓根钉棒固定。[结果]所有患者均成功实施手术,手术时间(139.24±35.36) min;术中出血量(275.13±93.22) ml,未出现神经根损伤。术后患者疼痛逐渐缓解,功能逐渐改善。至末次随访时所有患者均获得骨性融合,未见内固定松动、脱出、断裂。[结论]应用组合式椎间处理器并自体棘突椎板关节突骨块的椎间融合技术治疗峡部裂型腰椎滑脱症,术后植骨融合率高,内固定并发症发生率低,疗效确切。

[Objective] To introduce the surgical technique and preliminary clinical outcomes of lumbar interbody fusion with self-developed intervertebral processing instrument set and autogenous spinous process-lamina-facet bone block graft for isthmic spondylolisthesis. [Method] From January 2014 to January 2019, 157 patients underwent the surgical treatment as mentioned above for isthmic spondylolisthesis. During the operation, en bloc resection of the spinous process-lamina-facet bone block was performed for use in next step. The self-developed intervertebral processing instruments set was used to prepare the space, thread the upper and lower endplates, and reduce the slippage. The spinous process-lamina-facet bone block was trimmed to look like a fusion cage according to the target intervertebral space height. After granular bone graft impacted into the space, the bone block like cage was inserted into the intervertebral space, and fixed with the pedicle screw-rod system in anatomic alignment. [Results] All patients were successfully operated on with operation time of(139.24±35.36) min and intraoperative blood loss of(275.13±93.22) ml, whereas no nerve root injury occurred in anyone of them. As time went after the operation, the patient got pain relief and function improvement gradually. By the time of the last follow-up, all patients had achieved bone fusion with no loosening, prolapse, or breakage of the internal fixation. [Conclusion] The lumbar interbody fusion with this self-developed intervertebral processing instrument set and autogenous spinous process-lamina-facet bone block grafting for isthmic spondylolisthesis have advantages of improving intervertebral fusion and declining complication related to implant, do achieve satisfactory clinical outcomes.