应用Cage与Cage联合椎弓根螺钉系统行后路腰椎体间融合术

Comparison of Posterior Lumbar Interbody Fusion using Cage and Cage Combined with Pedicle Screw System

目的:比较单独应用Cage和Cage联合后路推弓根螺钉内固定行后路腰椎体间融合术(PLIF)的治疗效果;探讨降低术后并发症以及提高术后疗效与融合率的方法。方法:5年内随访到202例共243个节段(L_2～S_1)PLIF手术患者,单个节段手术单独用Cage 110例,联合使用椎弓根螺钉固定50例;双节段单独使用Cage 18例,联合使用椎弓根螺钉23例;3节段1例,使用Cage联合椎弓根螺钉内固定。均采用后侧入路斜向置入单枚长Cage,其中圆柱形螺纹Cage 100枚,接触式Cage 90枚,楔形53枚。术后平均随访2.8年(6月～4.5年),并行影像学评估和临床效果评价,包括X线片和薄层CT扫描;用ODI作术前/后的临床评价。结果:融合率术后6月90.1％(219)、12月93.0％(226)、24月95.1％(231);临床症状缓解率术后3月91.6％(185例),6月以上95.0％(192例);术后并发症:一过性足下垂和伸踇乏力30例;Cage后滑出3例(1.2％);术后脑脊液漏5例(2.4％);术后下腰痛持续3月者10例,持续6月者3例,1年以上者1例;术后内植物下沉、假关节形成者1例。结论:应用PLIF腰椎体间置入Cage行融合术是满意而可靠的方法,2节段以上单独应用Cage可发生内植物滑出、椎体塌陷等并发症,Cage联用椎弓根螺钉可以有效防止融合器的松动和后滑出,尤其是多节段的后路减压融合术时。良好的手术技巧以?

Objective: To compare the effect of posterior lumbar interbody fusion between using cage alone and cage combined with pedicle screw system, discuss the way to reduce postoperative complications and the way to improve fusion rate. Methods: Two hundred and two cases who received PLIF with cage or cage combined with pedicle screw yielded 243 operative lumbar segments from L2-S1 were followed up from 1996.1~2001.11,in which 110 cases who involved only one segment received cage only,other 50 who involved single segment received cage combined with pedicle screw; in those involving two segments 18 received cage alone and 23 combined with pedicle screw; only 1 case involved three segments and received cage combined with pedicle screw. A single cage was placed into each operative intervertebral space posterolaterally, in which 100 cylindrical threaded cage,90 contact cage,53 wedged cage were randomly used. Followed up period were from 6 months to 4.5 years, the Oswestry disability index was used to evaluate the curative effect,X-ray and laminal CT scanning were used to estimate fusion rate. Result:The fusion rate was 90.1% at 6 months,93% at 12 months,and 95.1% at 24 months postoperatively. The clinical symptom remission rate was 91.6% at 3 months and 95.0% at 6 months and later postoperatively. Postoperative com- plications: 30 cases suffered with transient nerve root injury and recovered in 3 months; 3 cases happened with cages retro-extrusion(1. 22%);5 cases met with CSF-leakage; 1 case of implant sinkage and pseuderarthritis. Conclusion: Posterior lumbar interbody fusion with cage is satisfactory and reliable in treating with lumbar disease. There are still some complications when using cage alone especially in multiple segments, cage combined with pedicle screw is effective in preventing the retro-extrusion and loosening even sinkage and collapse of the implant. Excellent operative technique and appropriate choice of cage is the key point for a successful treatment.