同时应用融合和非融合技术治疗创伤性腰椎间盘损伤(附4例临床病例报道及文献复习)

目的观察同时应用融合及非融合技术治疗腰椎间盘损伤的远期疗效,对照该术式与非手术治疗的远期疗效。方法对4例由于急性外伤引起的L4/L5及L5/S1椎间盘损伤患者进行影像学评价。根据生物力学稳定性对病变节段分别采用融合和非融合技术。手术全部经前路腹膜外切口。L5/S1采用椎间融合(自体髂骨 cage植入),L4/L5采用人工椎间盘植入。术后随访4年,摄术后X线正侧位、动力位片,术后2年MRI检查,SF36问卷调查。同期8例患者采用非手术治疗作为对照。结果术后6、12、24、36及48个月X线片显示,融合节段正侧位椎体间无移位,全部患者均有明显的骨性融合。非融合节段人工椎间盘假体位置良好,术后2年MRI显示有正常活动。同期8例非手术治疗患者5例缓解,3例因症状加重实施手术。结论前路融合技术可以有效稳定椎节,缓解腰椎不稳所致的疼痛。人工腰椎间盘植入可以有效地维持放射学稳定性,但不能完全替代正常椎间盘的功能。

Applying fusion and non-fusion techniques simultaneously in lumbar intervertebral disc injury(with report of four cases and literature review)

Objective To observe the Clinical outcomes of fusion and non-fusion technique simultaneously on the same patient, and compare the clinical outcomes to those of conservative treatment. Methods After radiographic evaluations of 4 cases of L4/L5 and L5S1 lumbar disc injury caused by acute trauma, fusion and non-fusion techniques were applied to the lesion segments respectively. Anterior operational approach was used in all cases. Anterior lumbar intervebody fusion (ALIF) was used to L5/S1, artificial disc replacement was used to L4/L5. All cases were followed up for 4 years, including post-operative X-ray, MRI two years later to operation, and SF36 Survey Scales investigation The control group was made up of 8 cases of the same injury at the same time. Results Obvious bone fusion was seen in all fusion segments in 6, 12, 24, 36 and 48 months X-rays, and there was no displacement between vertebral bodies. All artificial discs were in right position, MRI of two years after operation showed normal movement. Five cases of eight conservative treatments alleviated, and three cases underwent operation owing to aggravation. Conclusion Anterior fusion could effectively provide stability of vertebra, decrease pain caused by lumbar instability. Artificial lumbar disc could maintain radiographic stability, but it could not substitute for normal lumbar disc in all functions.