腰椎椎间融合系统的临床应用

Clinical application of interbody cage systems in the lumbar spine

目的 :探讨腰椎椎间融合器 (Interbodycage)在各种导致腰椎失稳疾病的手术治疗中的应用价值 ,并进行相关生物力学分析。方法 :后路运用BagbyandKuslich融合器 (BAK cage)、螺纹融合装置 (ThreadedFusonCage ,TFC)治疗腰椎间盘突出症 18例 ,腰椎管狭窄症 37例 ,腰椎滑脱 2 3例 ,创伤性滑脱 19例 ,其中 36例与椎弓根装置联合应用 ;前路运用块状cage、BAK cage、TFC治疗机械性腰痛 13例 ,其中 4例系再次手术 ;前路运用新型Mesh cage进行椎体肿瘤减压术后脊柱重建 8例 ,椎体爆裂性骨折 2例 ,骨质疏松症并椎体压缩骨折 1例。结果 :6 3例平均随访 2 1个月 ,后路应用BAK cage和TFC治疗腰椎退行性疾病的临床优良率为 91 2 % ,滑脱复位率为 89% ,创伤性错位 10 0 %复位 ;前路应用椎间融合器治疗慢性腰痛的临床优良率为 94 6 % ,半年时X线评价骨融合率达 95 %。三个月的初步观察显示 ,钛网椎间融合器在椎体切除后的重建中起重要作用 ,患者术前的症状缓解 ,活动能力明显提高。结论 :不论在腰椎退行性疾病、创伤性疾病、骨质疏松并发的椎体塌陷 ,还是在椎体肿瘤根治术后重建等需要行腰椎椎间界面融合的病例中 ,腰椎椎间融合器的应用由于其具有撑开 压缩功能和载荷均分能力等优良的生物力学特征 ,不但能使失稳脊柱?

Objective To study the clinical value of interbody cage systems in the surgical treatment of unstable lumbar segment, and evaluate the biomechanical properties. Methods Ninety seven cases were selected for operation by posterior lumbar interbody fusion with the BAK cage or TFC device. Of the patients, 18 were diagnosed as lumbar disc degeneration disease (DDD), 37 as lumbar stenosis, 23 as spondylolisthesis, and 19 as unstable traumatic lesion. Thirty six of them received additional posterior pedicle devices; 13 cases with severe mechaninical back pain underwent anterior interbody fusion with the BAK cage or TFC or interbod spacer, 4 of them underwent surgery once again. A new anterior Mesh cage was used in spinal reconstruction for some patients, including 8 patients with thoracolumbar tumor, 2 with lumbar burst fracture, and 1 with osteoportic late collapse of a vertebral body. Results In the follow up for an average of 21 months, 63 patients were available for review. The clinical results were excellent and good in 91.2% of the patients who underwent posterior interbody cage fusion; the preoperative percentage of slip was corrected in 89% of the patients with spondlyolithsis and in 100% of the patients with traumatic dislocation. The satisfactory rate was 94.6% in the patients with severe back pain who underwent anterior interbody cage fusion. The rate of union in the grafted area was 95% at the 6 th month after the operation. A preliminary experience showed that the clinical effect was obvious as the Mesh cage was used in the patients with tumor, symtoms were relieved and motion ability was greatly improved in these patients. Conclusion The interbody cage implant produces immediate stabilisation on unstable spinal segments, offers a conductive biomechanical environment for interbody graft healing by distraction properties and weight bearing function, and restores the normal interbody space and spinal column lordosis with satisfactory clinical effects on such diseases as DDD, traumatic lesion, osteoporotic late collapse of a vertebral body and spinal tumors.