人工椎体置换行脊柱重建术

Spinal reconstruction by artificial vertebral body replacement

目的 :分析人工椎体行脊柱重建术的手术方法选择和临床效果。方法 :1997年 8月～ 2 0 0 2年 12月 ,应用人工椎体行颈、胸、腰、骶椎椎体重建术 3 1例。观察患者神经症状恢复及椎节高度、椎间角、人工椎体植入位置变化等。结果 :平均随访 16个月 ,所有患者疼痛缓解或消失 ,2 4例神经功能较术前改善。术后早期椎节高度较术前平均增加 3mm ,术后 3个月椎节有不同程度塌陷 ;术后椎间角较术前平均减少 6 6°。人工椎体在椎体中部者 14例 ,中部偏后 4例 ,中部偏前 1例 ,其余 12例 (3 9% )人工椎体在椎体侧方或倾斜放置。无人工椎体脱落或滑出。结论 :人工椎体置换可满意恢复椎节高度及生理曲度 ,有效重建脊柱稳定性 ,但应尽量避免其斜放或偏向一侧放置。人工椎体是否附加内固定取决于病变的部位、切除范围、患者的年龄、职业、人工椎体种类等。

Objective:To investigate the methods selection and clinical outcome of the artificial vertebral body for spine corpectomy.Method:From Aug. 1997 to Dec. 2002,31 cases performed corpectomy and artificial vertebral body (AVB) replacement were included.The restoration of spinal segment height,cervical lordorsis and location of artificial vertebral body were evaluated.Result:Averagely 16 month-follow up showed that pain released in all patients and neurofunction improved in 24 cases after operation.The spinal segment height increased average 3mm after operation and the intervertebral body angle restored 6.6° .The AVB located in neutral zone of the vertebral body in 14 cases and posterior in 4,anterior in 1 and lateral or oblique in 12.No AVB migration was observed during follow-up.Conclusion:AVB can reconstruct the height and lordorsis of spinal segment ideally,but an oblique or lateral position should be avoided.It's depending on the location of the lesions,range of excision and patient's age,profession and the type of AVB when an AVB implantation alone or supplemented with fixation should be considered.