n-HA/PA66复合材料融合器在后路经椎间孔腰椎椎体间融合术中的应用研究

目的分析纳米羟基磷灰石/聚酰胺66(n-HA/PA66)复合材料融合器在治疗腰椎退行性疾病中的作用及效果。方法应用n-HA/PA66复合材料融合器对20例腰椎退行性疾病行经椎间孔腰椎椎体间融合术(TLIF),通过测量术前、术后1周、术后2个月腰椎曲线指数、相对椎间隙高度、Tailard指数、节段前凸角、全腰椎前凸角等影像学检查指标及Gree-nough临床疗效标准等,评价手术疗效。结果除了Tailard指数,其余影像学观察指标术后1周、术后2个月与术前比较,差异均有统计学意义(P<0.01667)。在腰痛、腿痛,术前、术后1周、术后2个月三者之间两两比较差异均有统计学意义(P<0.01667)。根据Greenough临床疗效标准评估临床效果,疗效优良率达95%,术后无严重并发症。结论 n-HA/PA66复合材料融合器可有效治疗腰椎退行性疾病,可防止椎间高度塌陷下沉、解除神经根受压,是一种疗效理想的椎间融合器材料。     

椎间融合器与椎弓根系统复位固定治疗腰椎滑脱症

目的:总结椎间融合器加椎弓根系统复位固定治疗腰椎滑脱的适应证、疗效及并发症。方法:1999年3月~2002年5月间对31例腰椎滑脱患者行椎间融合器加椎弓根系统复位固定、后外侧融合手术治疗,观察术前、术后和随访期间Taillard指数、Boxall指数、滑脱角、腰椎生理前凸角、椎间隙高度指数的变化;同时观察临床疗效及融合率。结果:31例平均随访19个月(6~36个月),术前与术后的Taillard指数、Boxall指数、滑脱角、腰椎生理前凸角、椎间隙高度指数有显著性差异(P<0.01);术后与随访时比较无显著性差异。优良率为93.55%,融合率为100%。并发症有硬膜损伤致脑积液漏1例,cage位置不佳1例,L5神经根损伤1例,无断钉和断棒现象。结论:椎间融合器加椎弓根系统复位固定、后外侧融合手术治疗腰椎滑脱近期疗效满意,能克服单纯使用cage治疗腰椎滑脱所引起的并发症。     

纳米羟基磷灰石/聚酰胺66椎间融合器植骨融合治疗下腰椎退变性疾病的近期疗效

目的评价使用纳米羟基磷灰石/聚酰胺66(nano-hydroxyapatite/polyamide-66,n-HA/PA66)椎间融合器行椎间融合术治疗下腰椎退变性疾病的近期疗效。方法 2011年1月-10月,对20例下腰椎退变性疾病患者行经椎间孔入路n-HA/PA66椎间融合器支撑植骨融合内固定术治疗。男8例,女12例;年龄22～80岁,平均51岁。病程1～24个月,平均4个月。手术融合节段:L4、58例,L5、S19例,L4～S13例。腰椎间盘突出症术后复发3例,腰椎退变性滑脱症5例,腰椎峡部裂滑脱症9例,腰椎管狭窄症3例。手术前后行X线片及CT三维重建检查,测量患者融合节段椎间隙高度及前凸曲度以评价手术效果,观察植骨融合情况。采用Oswestry功能障碍指数(ODI)下腰痛评分及简明健康调查量表(SF-36)评分评价患者症状改善情况。结果术后患者切口均Ⅰ期愈合,腰腿疼痛、麻木等症状均有不同程度缓解,未出现脑脊液漏、神经根损伤、伤口感染等并发症。20例均获随访,随访时间6～9个月,平均7个月。未发生椎间融合器移位、塌陷等情况。术后3 d,3、6个月及末次随访时所有融合节段的椎间隙高度及前凸曲度均较术前显著改善(P<0.01);术后各时间点间比较,差异均无统计学意义(P>0.05)。椎间植骨融合时间3～9个月,平均4个月。术后3个月椎间植骨融合率为74%,术后6个月为96%。患者术后3 d及6个月时的ODI及SF-36评分均较术前显著提高(P<0.01),术后两时间点间比较,差异无统计学意义(P>0.05)。结论应用n-HA/PA66椎间融合器行椎间融合术治疗下腰椎退变性疾病安全有效;n-HA/PA66椎间融合器具有植骨融合率高、下沉率低及透射X线等优点,是一种较为理想的椎间支撑植骨材料,但远期疗效有待进一步观察。     

多孔纳米羟基磷灰石-聚酰胺66椎间融合器治疗胸腰椎爆裂骨折的早期临床研究

目的 评价多孔纳米羟基磷灰石-聚酰胺66椎间融合器(n-HA/PA66 cage)治疗胸腰椎爆裂骨折的早期临床效果.方法 2008年1月至2008年9月,对54例胸腰椎爆裂骨折患者采用前路减压多孔n-HA/PA66 cage支撑植骨融合固定治疗.术前、术后1周内、3、6个月、1年随访时进行随访,用Frankel法记录患者神经功能,并行X线片及三维CT检查.采用Cobb法测最后凸情况,并测最伤椎邻近上、下椎体间高度,采用Brantigan等描述的方法观察融合情况.结果 术后无神经损害加重;除2例Frankel A级和8例D级患者外,其余患者神经功能均有1～2级的恢复.平均随访9.4个月(6～12个月).术前平均矢状位后凸角14.4°±12.6°,术后为3.7°±8.7°,末次随访时3.9°±8.5°.术前平均伤椎邻近上、下椎体间高度为(96.9±17.2)mm,术后为(109.5±17.1)mm,末次随访时为(108.6±16.9)mm.随访期间未见cage移位、内同定断裂及神经功能损害加重.19例达到E级融合,10例达到D级融合,25例达到C级融合.结论 前路减压多孔n-HA/PA66 cage支撑植骨融合固定治疗胸腰椎爆裂骨折安全可行,术后椎间高度恢复满意,后凸畸形纠正明显,随访过程中丢失少,并能获得满意融合.     

同一患者应用自体骨植骨和椎间融合器行椎体间融合术治疗腰椎滑脱症的比较研究

背景：目前国内外公认椎体间融合术（PLIF）是治疗腰椎滑脱症的最佳手术方式,但椎间融合器的应用尚存争议。目的：比较同一患者应用自体骨植骨和椎间融合器行PLIF治疗不同节段腰椎滑脱症的临床疗效。方法：2008年3月至2012年1月收治两节段腰椎滑脱症患者61例,两个病变节段分别应用自体骨植骨和椎间融合器行腰椎后路PLIF。术前、术后和随访期间的日本骨科学会（JOA）下腰痛功能评分、Oswestry功能障碍指数（ODI）、视觉模拟评分（VAS）进行临床疗效评估;Tailland指数、Boxal指数、滑脱角、腰椎生理前凸角进行影像学疗效评估;Suk法进行椎间融合评估;测量比较各节段的椎间隙及椎间孔高度。结果：全部获得随访,随访时间为11~47个月,平均28.4个月。JOA评分治疗改善优良率为91.8%,术后JOA评分、ODI、VAS、Tailland指数、Boxal指数、滑脱角、腰椎生理前凸角均较术前明显好转（P〈0.01）,且末次随访无丢失（P〉0.05）。应用自体骨植骨的融合时间为（8.8±3.4）个月,融合率为93.4%;应用椎间融合器的融合时间为（9.4±2.9）个月,融合率为95.1%,两种椎间融合方式的融合时间及融合率相比较均无统计学差异（P〉0.05）。术后各腰椎间隙前缘高度、后缘高度、平均高度及椎间孔高度均较术前明显提高（P〈0.01）,但两种椎间融合方式术前和术后的腰椎间隙前缘高度、后缘高度、平均高度及椎间孔高度相比较无统计学差异（P〉0.05）。自体骨植骨椎间融合方式末次随访的椎间隙前缘高度、平均高度及椎间孔高度与术后比较丢失明显（P〈0.05）。结论：两种椎间融合方式均获得良好的临床疗效及椎间融合,而椎间融合器在维持椎间高度方面表现优异,其联合前方自体骨植骨可以作为PLIF的理想椎间融合选择。     

不同终板形态对经椎间孔入路腰椎椎间融合术后融合器沉降的影响

目的　探讨不同椎体终板形态对经椎间孔入路腰椎椎间融合术(TLIF)后融合器沉降发生率的影响。方法回顾性分析2015年1月—2016年8月接受TLIF治疗的75例单节段腰椎退行性疾病患者的临床和影像学资料。根据术前矢状面MRI椎体终板形态分为规则组54例(A组)和不规则组21例(B组),比较2组患者术前、术后及末次随访时腰椎侧位X线片上测量的影像学参数(椎间隙高度、椎间孔高度、腰椎前凸角及腰椎局部前凸角),采用Oswestry功能障碍指数(ODI)评估患者腰椎功能,采用腰痛和下肢痛视觉模拟量表(VAS)评分评估患者生活质量。结果所有手术顺利完成。所有患者术后随访2.0 ～ 3.9(2.7±0.7)年。末次随访时,B组椎间隙高度及腰椎局部前凸角矫正丢失率高于A组,差异有统计学意义(P 0.05);2组椎间孔高度和腰椎前凸角矫正率无明显丢失。末次随访时,2组患者ODI及腰痛、下肢痛VAS评分较术前显著改善,B组腰痛VAS评分高于A组,差异均有统计学意义(P 0.05)。末次随访时,16例(21.3%)患者发生融合器沉降,A组7例(13.0%),B组9例(42.9%);其中重度沉降3例,A组1例,B组2例。结论终板形态不规则患者TLIF术后融合器沉降发生率显著高于终板形态规则患者,且术后易发生椎间隙高度及腰椎局部前凸角的矫正度丢失。     

后路椎弓根内固定联合cage椎间融合器与髂骨块椎间融合治疗腰椎不稳症

目的：比较在双侧椎弓根内固定情况下,应用cage椎间融合器行椎间融合与传统髂骨块植骨椎间融合治疗腰椎不稳症的临床效果。方法：78例椎间融合内固定术治疗的腰椎不稳症患者,在双侧椎弓根内固定和椎管减压的基础上,42例行cage融合器椎体间植骨（A组,植骨仅用减压时取下的松质骨）,36例取自体髂骨块行椎体间植骨（B组）。观察比较两组患者的症状改善率、椎间隙高度及腰椎生理前凸角的变化、植骨融合率和术后并发症的情况。结果：78例患者获得12~48个月随访,术前和术后2周的椎间隙高度、腰椎生理前凸角比较,差异有统计学意义（P〈0.05）,症状改善。A组优良率92.86%,B组72.22%（P〈0.05）;植骨融合率A组95.24%,B组83.33%（P〈0.05）。结论：两种方式治疗腰椎不稳症,均能有效的恢复腰椎的稳定性,cage椎体间融合在症状改善、椎间融合率、椎间隙高度及腰椎生理前凸角的维持、并发症的发生方面比髂骨块植骨椎间融合有较明显的优势。     

单枚Cage在腰椎退行性病变治疗中的疗效分析

目的探讨单枚Cage在腰椎退行性病变治疗中的临床疗效。方法采用后路节段性内固定加单枚Cage斜放治疗腰椎不稳、腰椎管狭窄症、退变性腰椎滑脱、椎间盘术后复发等退行性腰椎病变112例。通过测量X线片及进行NaKai评分,观察术前、术后及末次随访时腰椎曲线指数、相对椎间隙高度、Taillard指数、节段前凸角、腰椎生理前凸角、融合判断标准及临床疗效。结果本组共81例获得6～50个月的随访,平均20.3个月,患者腰腿痛均有不同程度的改善,根据NaKai评分标准进行评价,优44例,良29例,可6例,差2例,优良率为90.1%。内固定材料无松动、断裂,单枚Cage置入融合术后3～12个月X线片示达到骨性融合标准。腰椎曲线指数、节段前凸角、腰椎生理前凸角术前、术后无明显差异。Taillard指数、相对椎间隙高度术前、术后有明显差异。结论应用单枚Cage治疗腰椎退行性病变,能够有效地维持椎间隙高度,脊柱融合可靠,是一种比较理想的腰椎融合术式。     

双枚融合器行腰椎椎间融合术治疗腰椎退行性疾病的疗效

目的 探讨双枚融合器行腰椎椎间融合术(PLIF)治疗腰椎退行性疾病的疗效。方法 将60例腰椎退行性疾病患者根据PLIF术中置入融合器数量的不同分为双枚组(30例)和单枚组(30例)。比较两组疼痛VAS评分、ODI评分、椎间隙高度、腰椎局部前凸角、椎间融合及融合器沉降情况。结果 患者均获得随访，时间1～3年。末次随访时，两组腰痛及下肢痛VAS评分、ODI评分均较术前明显改善(P<0.05),但组间比较差异均无统计学意义(P>0.05)。椎间隙高度及腰椎局部前凸角：两组术后7 d、末次随访时较术前均明显改善(P<0.05);末次随访时，单枚组较术后7 d均有明显丢失(P<0.05),双枚组较术后7 d均无明显丢失(P>0.05),双枚组均显著优于单枚组(P<0.05)。末次随访时，椎间融合率单枚组低于双枚组(P<0.05),融合器沉降率单枚组高于双枚组(P<0.05)。结论 双枚融合器行PLIF治疗腰椎退行性疾病可降低术后融合器的沉降发生率，提高椎间融合率，良好维持术后椎间隙高度及腰椎局部前凸角。     

经椎间孔入路腰椎椎间融合术中融合器位置对融合器沉降的影响

目的评估经椎间孔入路腰椎椎间融合术(TLIF)中融合器位置对融合器沉降发生率的影响。方法回顾性分析2010年1月—2014年12月接受L_4/L_5单节段TLIF的83例腰椎退行性疾病患者的临床和影像学资料。根据术后即刻CT平扫上融合器与L_5椎体上终板的相对位置,将患者分为中央组(37例)与边缘组(46例),比较2组患者手术前后影像学参数(椎间隙高度、椎间孔高度、腰椎局部前凸角)及疼痛视觉模拟量表(VAS)评分等指标。结果2组患者术后即刻、末次随访时椎间隙高度、椎间孔高度及腰椎局部前凸角较术前明显升高,差异均有统计学意义(P 0.05);末次随访时,中央组患者椎间隙高度、腰椎局部前凸角较术后即刻均有明显丢失,差异均有统计学意义(P 0.05);末次随访时,边缘组患者椎间隙高度、腰椎局部前凸角显著高于中央组,差异均有统计学意义(P 0.05)。末次随访时,2组患者腰痛及下肢痛VAS评分较术前均明显改善,差异有统计学意义(P 0.05),但组间比较差异无统计学意义(P 0.05)。末次随访时共18例发生融合器沉降,中央组12例(32.4%),1例重度沉降,11例轻度沉降;边缘组6例(13.0%)均为轻度沉降,2组沉降率差异有统计学意义(P 0.05)。结论 TLIF中融合器位于终板中央区域会增加术后融合器沉降发生率,术中置入融合器时应放置于终板边缘区域,以降低术后融合器沉降的风险。     

腰椎融合器在腰椎退行性病变治疗中的疗效分析

目的:分析80例使用腰椎融合器患者的疗效,评价腰椎融合器在治疗退行性病变腰椎疾病中的应用效果。方法:应用相对椎间隙高度、Taillard指数、腰椎曲线指数、节段前凸角、全腰椎前凸角等影像学检查指标及Greenough临床疗效标准,对80例使用腰椎融合器的腰椎退行性变的患者进行临床随访,对比分析术前术后及随访结果,评价治疗效果。结果:所有患者术前相对椎间隙高度平均为0·69(0·62~0·76),术后平均为1·24(1·14~1·34);Taillard指数术前平均为0·32(0·24~0·40),术后平均为0·03(0·02~0·04),手术疗效良好率达到91%。术后出现1例融合失败,发生率为1%。结论:腰融合器是治疗腰椎退行性病变的有效方法,应用时应掌握其准确的适应证和植入技术,避免并发症发生。     

椎弓根螺钉系统加cage融合器治疗腰椎滑脱症疗效分析

目的分析椎弓根螺钉系统加cage融合器治疗腰椎滑脱症的疗效。方法2003年2月～2006年3月,联合应用椎弓根螺钉系统加cage融合器治疗腰椎滑脱症患者37例。男21例,女16例;年龄39～69岁。滑脱部位：L33例,L423例,L511例。根据Meyerding滑脱程度分级标准,度滑脱12例,度滑脱20例,度滑脱5例。观察术前、术后2周及3个月随访时Taillard指数、Boxall指数、滑脱角、腰椎生理前凸角及椎间隙高度的变化情况。结果37例患者术后均获3～36个月随访。术前与术后2周Taillard指数、Boxall指数、腰椎生理前凸角、滑脱角及椎间隙高度比较,差异均有统计学意义（P〈0.05）;各指标术后3个月与术后2周比较,差异均无统计学意义（P〉0.05）。根据邹德威评分标准,优27例,良8例,可2例,优良率达94.6%。患者术后3～8个月植骨均融合,平均3.9个月。内固定材料无松动、断裂,cage融合器位置、形态正常。结论联合应用椎弓根螺钉系统和cage融合器治疗腰椎滑脱症可起到协同作用,能提供理想复位和坚强内固定,提高脊柱的融合率,是治疗腰椎滑脱症的一种较理想方法。     

颈前路椎管减压植骨融合内固定术中应用钛笼与n-HA/PA66人工椎体的疗效比较

目的比较颈椎病颈前路椎管减压植骨融合内固定术中置入钛笼与置入纳米羟基磷灰石/聚酰胺66(nanohydroxyapatite/polyamide66,n-HA/PA66)人工椎体的疗效。方法回顾性分析自2012-01—2017-02采用颈前路椎管减压植骨融合内固定术治疗的97例颈椎病,50例在术中置入钛笼(钛笼组),47例在术中置入n-HA/PA66人工椎体(人工椎体组),比较2组术后即刻、术后3个月、术后6个月颈椎前凸角度与JOA评分,比较2组术后椎体下沉情况以及末次随访时神经功能改善等级。结果97例均顺利完成手术并获得完整随访,随访时间平均10.4(6~18)个月。末次随访时97例均获得骨性融合。2组术后即刻、术后3个月、术后6个月颈椎前凸角度、JOA评分比较差异无统计学意义(P>0.05)。术后6个月钛笼组6例出现钛笼下沉现象,人工椎体组未出现人工椎体下沉现象。人工椎体组椎体下沉情况较钛笼组优,差异有统计学意义(P<0.05)。2组末次随访时神经功能改善等级比较差异无统计学意义(P>0.05)。结论钛笼与n-HA/PA66人工椎体均能有效重建颈椎的稳定性、改善脊髓功能并获得良好的植骨融合率,n-HA/PA66人工椎体置入后可以获得较低的椎体下沉率。     

Outcome of single level anterior cervical discectomy and fusion using nano-hydroxyapatite/polyamide-66 cage

Background:

Cages have been widely used for the anterior reconstruction and fusion of cervical spine. Nonmetal cages have become popular due to prominent stress shielding and high rate of subsidence of metallic cages. This study aims to assess fusion with n-HA/PA66 cage following one level anterior cervical discectomy.

Materials and Methods:

Forty seven consecutive patients with radiculopathy or myelopathy underwent single level ACDF using n-HA/PA66 cage. We measured the segmental lordosis and intervertebral disc height on preoperative radiographs and then calculated the loss of segmental lordosis correction and cage subsidence over followup. Fusion status was evaluated on CT scans. Odom criteria, Japanese Orthopedic Association (JOA) and Visual Analog Pain Scales (VAS) scores were used to assess the clinical results. Statistically quantitative data were analyzed while Categorical data by χ² test.

Results:

Mean correction of segmental lordosis from surgery was 6.9 ± 3.0° with a mean loss of correction of 1.7 ± 1.9°. Mean cage subsidence was 1.2 ± 0.6 mm and the rate of cage subsidence (>2 mm) was 2%. The rate of fusion success was 100%. No significant difference was found on clinical or radiographic outcomes between the patients (n=27) who were fused by n-HA/PA66 cage with pure local bone and the ones (n=20) with hybrid bone (local bone associating with bone from iliac crest).

Conclusions:

The n-HA/PA66 cage is a satisfactory reconstructing implant after anterior cervical discectomy, which can effectively promote bone graft fusion and prevent cage subsidence.     

The impact of interbody approach and lumbar level on segmental,adjacent, and sagittal alignment in degenerative lumbar pathology: a radiographic analysis six months following surgery

BACKGROUND CONTEXTInterbody fusion, including: transforaminal (TLIF), posterior (PLIF), anterior (ALIF), and lateral (LLIF); effectively treat lumbar degenerative pathology and provide spinopelvic balance. Although the decision on surgical approach and technique are multifactorial and patient specific, the impact of the interbody approach on segmental and adjacent level lordosis could be an important factor to consider during pre-operative planning to achieve pre-specified alignment goals.PURPOSEThe purpose of this study is to compare the 6-month postoperative radiographic outcomes in the lumbar spine following 1 to 2 level transforaminal (TLIF), posterior (PLIF), anterior (ALIF), and lateral (LLIF) interbody fusions at the L3-4, L4-5, and L5-S1 levels. As our primary outcome, we evaluated the change in segmental lordosis at the level of fusion in ALIF/LLIF approaches compared to TLIF/PLIF. Secondarily, we evaluated the pelvic incidence to lumbar lordosis (PI-LL) mismatch and examined the compensatory lordotic changes at the adjacent levels 6 months following surgery.STUDY DESIGNRetrospective cohort.PATIENT SAMPLEThis retrospective study included 18 centers of various practice settings across the United States. Patients were included in the study if they underwent a one- or two-level primary lumbar fusion for degenerative pathology.OUTCOMES MEASURESMeasurements of the pre-operative and 6-month post-operative lumbar AP and lateral lumbar plain radiographs included: pelvic incidence (PI), pelvic tilt, lumbar lordosis from L1-S1 (LL), as well as segmental lordosis (SL) of each segment between L1-S1.METHODSDue to there being 2 evaluated time points, patients were then grouped based on alignment into categories of preserved, restored, not corrected, and worsened.RESULTS474 patients underwent 608 levels of fusion. ALIF/LLIF resulted in significantly more segmental lordosis compared to TLIF/PLIF procedures at both L4-5 and L5-S1 (p<.001). Overall, ALIF/LLIF resulted in significantly more global lumbar lordotic alignment change compared to TLIF/PLIF (p=.01). Whether patients’ alignment was preserved versus worsened was not significantly predicted by type of procedure. Similarly, whether patients’ alignment was restored versus not corrected was not significantly predicted by type of procedure. Finally, anterior approaches resulted in decreased lordosis at adjacent levels, thus resulting in a more neutral position.CONCLUSIONIn this large multicenter retrospective study of 1 to 2 level interbody fusion surgeries, we identified that A/LLIF procedures at L4-L5 and L5-S1 resulted in greater segmental lordosis restoration and PI-LL mismatch improvement compared to T/PLIF procedures. A/LLIF may also significantly reduce lordosis (compared to T/PLIF) at the adjacent levels in a fashion that serves to reduce the lumbar lordosis that may have been increased at the fused level.     

通道辅助下微创椎间融合术联合短节段病椎固定治疗非特异性腰椎间隙感染

目的:探讨通道辅助下微创经椎间孔腰椎椎间融合(minimally invasive transforaminal lumbar interbody fusion,MIS-TLIF)技术联合经皮短节段病椎固定治疗非特异性腰椎椎间隙感染的疗效。方法:回顾性分析2014年1月至2018年1月12例非特异性腰椎椎间隙感染患者的资料,其中男8例,女4例,年龄39～65(51.00±12.36)岁。感染部位:L_(2,3)2例,L_(3,4)3例,L_(4,5)6例,L_5S_11例。其中合并高血压3例,糖尿病2例,泌尿系感染2例。12例患者均无腰部穿刺及手术史。所有患者行Quadrant通道辅助下MIS-TLIF技术病灶清除、自体植骨融合,经皮短节段病椎椎弓根螺钉内固定术,术中取病变组织行细菌培养和病理检查。记录手术时间、术中出血量、术前和术后1周及随访期间的红细胞沉降率(erythrocyte sedimentation rate,ESR)及C-反应蛋白(C-reactive protein,CRP);采用视觉模拟评分(visual analogue scale,VAS)和日本骨科协会(Japanese Orthopaedic Association,JOA)评分来评价临床疗效;采用影像学资料评估腰椎融合情况。结果:所有患者手术顺利,手术时间(176.00±20.76) min,术中出血量(155.00±30.56) ml。术后随访12～18(14.69±4.78)个月。术后1周及末次随访时的VAS及JOA评分较术前明显改善(P0.01)。末次随访JOA改善率为94%,所有患者红细胞沉降率及C-反应蛋白降至正常,植骨获骨性融合。病变组织细菌培养阳性7例,阴性5例。结论:通道辅助下MIS-TLIF技术病灶清除、自体植骨融合,联合短节段病椎固定,是一种临床疗效可靠、安全、微创的治疗非特异性腰椎间隙感染的手术方法。     

减压碎骨块行椎间融合治疗退变性腰椎不稳并狭窄病例对照研究

目的:探讨自体减压碎骨块在椎间融合中的价值。方法 :2014年4月至2015年5月,采用后路全椎板减压钉棒固定单侧改良TLIF入路椎间融合治疗退变性腰椎不稳并狭窄42例,男18例,女24例,其中24例单纯用自体减压碎骨块为椎间融合材料(治疗组),18例用cage加自体骨作为椎融合材料(对照组)。分析两组临床资料情况,对比两种治疗方式的骨性愈合时间、椎间融合率、椎间隙高度以及疗效的差异。结果:42例患者均获得随访,时间12~24个月,平均16个月。两组患者在发病年龄、性别比例、腰椎不稳程度及随访时间上差异无统计学意义(P0.05);两组患者在临床疗效、椎间高度丢失情况、椎间融合率的差异也无统计学意义(P0.05)。结论:利用减压碎骨块行椎间融合治疗退变性腰椎不稳并狭窄,术后融合率高,椎间隙高度维持良好,临床疗效满意,设计科学合理,并发症少,为治疗退变性腰椎管不稳并椎管狭窄提供了经济、实用、临床疗效确切的治疗方法。     

Early bone ingrowth and segmental stability of a trussed titanium cage versus a polyether ether ketone cage in an ovine lumbar interbody fusion model

BACKGROUND CONTEXTLumbar interbody fusion is an effective treatment for unstable spinal segments. However, the time needed to establish a solid bony interbody fusion between the two vertebrae may be longer than twelve months after surgery. During this time window, the instrumented spinal segment is assumed to be at increased risk for instability related complications such as cage migration or subsidence. It is hypothesized that the design of new interbody cages that enable direct osseointegration of the cage at the vertebral endplates, without requiring full bony fusion between the two vertebral endplates, might shorten the time window that the instrumented spinal segment is susceptible to failure.PURPOSETo quantify the bone ingrowth and resulting segmental stability during consolidation of lumbar interbody fusion using two different cage types.STUDY DESIGNPreclinical ovine model.METHODSSeven skeletally mature sheep underwent bi-segmental lumbar interbody fusion surgery with one conventional polyether ether ketone (PEEK) cage, and one newly developed trussed titanium (TT) cage. After a postoperative time period of 13 weeks, non–destructive range of motion testing, and histologic analysis was performed. Additionally, sample specific finite element (FE) analysis was performed to predict the stability of the interbody fusion region alone.RESULTSPhysiological movement of complete spinal motion segments did not reveal significant differences between the segments operated with PEEK and TT cages. The onset of creeping substitution within the cage seemed to be sooner for PEEK cages, which led to significantly higher bone volume over total volume (BV/TV) compared with the TT cages. TT cages showed significantly more direct bone to implant contact (BIC). Although the mean stability of the interbody fusion region alone was not statistically different between the PEEK and TT cages, the variation within the cage types illustrated an all-or-nothing response for the PEEK cages while a more gradual increase in stability was found for the TT cages.CONCLUSIONSSpinal segments operated with conventional PEEK cages were not different from those operated with newly developed TT cages in terms of segmental stability but did show a different mechanism of bone ingrowth and attachment. Based on the differences in development of bony fusion, we hypothesize that TT cages might facilitate increased early segmental stability by direct osseointegration of the cage at the vertebral endplates without requiring complete bony bridging through the cage.CLINICAL SIGNIFICANCEInterbody cage type affects the consolidation process of spinal interbody fusion. Whether different consolidation processes of spinal interbody fusion result in clinically significant differences requires further investigation.     

Does Preoperative Modic Changes Influence the Short-term Fusion Rate of Single Level Transforaminal Lumbar Interbody Fusion?—a Matched-pair Case Control Study

Objective

At present, the influence of Modic changes (MCs) on postoperative fusion rate of lumbar interbody fusion (LIF) is mainly focused on the medium- and long-term fusion rate, while the short-term fusion rate has not been reported. The aim of this study was to compare the short-term fusion rate of lumbar degenerative disease patients with and without MCs after single level transforaminal lumbar interbody fusion (TLIF).

Methods

In this retrospective and matched-pair case control study, we included 100 patients who underwent TLIF from January 2017 to January 2020 and had at least two follow-up visits over a two-year period. Fifty patients with MCs (MCs group) were matched with 50 patients without MCs (non MCs group) for age, sex, surgical level, diagnosis, operative time, and intraoperative blood loss. We collected the X-ray and computed tomography (CT) data of patients from 3 months to 2 years after the operation to assess bony fusion and the cage union ratio. According to the type of cage, the MCs group was further divided into the nano-hydroxyapatite/polyamide 66 (n-HA/PA66) group and polyetheretherketone (PEEK) group, and the fusion performance between the two groups was compared. Finally, age, sex, body mass index (BMI), smoking and cage type were included in the logistic regression model for risk factor analysis.

Results

The bony fusion rates in the MCs group at 3 months, 6 months, 1 year and 2 years after surgery were significantly lower than those in the non MCs group (P < 0.05) (23.8% vs 62.5%, 52.6% vs 78.9%, 61.1% vs 83.3%, 74.0% vs 90.0%). The average coronal cage union ratios of the upper and lower endplates in the MCs group were significantly lower than those in the non MCs group (54.3% ± 17.5% vs 75.0% ± 17.2%, P < 0.05; 73.3% ± 12.0% vs 84.9% ± 8.0%, P < 0.05). Similarly, analogous results were obtained by comparing the MCs and non MCs groups' three-dimensional CT sagittal plane images (62.5% ± 16.5% vs 76.1% ± 12.4%, P < 0.05; 67.0% ± 13.9% vs 79.8% ± 11.5%, P < 0.05).

Conclusion

Short-term fusion rates were lower in the MCs group than in the non MCs group. The coronal and sagittal cage union ratio in the MCs group was lower than that in the non MCs group. The fusion performance of n-HA/PA66 and PEEK cages in the MCs group was comparable.     

前路减压n-HA/PA66支撑体植骨融合术治疗下颈椎骨折脱位的临床观察

目的：探讨前路减压、纳米羟基磷灰石／聚酰胺66（n-HA／PA66）支撑体植骨融合内固定术治疗下颈椎骨折脱位的中期临床效果。方法：回顾性分析2008年1月至2010年12月应用n-HA／PA66支撑体行植骨融合术治疗的42例下颈椎骨折脱位患者的临床资料,其中男29例,女13例;年龄20～65岁,平均46．8岁。损伤节段：C35例,C414例,C,12例,C67例,C74例。伤后神经功能损伤按Frankel分级：A级4例,B级11例,C级13例,D级9例,E级5例。28例行前路伤椎次全切减压,14例行椎问盘切除减压。根据FrankeⅠ分级评估神经功能恢复程度;依据疼痛视觉评分（VAS）评价临床症状改善情况;通过颈椎侧位X线片评估融合节段高度以及前凸角度;通过三维CT评估支撑体位置、外形以及植骨块融合情况。结果：42例均获随访,时间3-5．2年,平均4．1年。术后神经功能Frankel分级：A级2例,B级3例,C级11例,D级8例,E级18例,较术前明显改善（Z=-4．845,P〈0．001）。术后3d及朱次随访时VAS评分分别为2．6±1．8和1．3±1．0,均较术前改善（P〈0．05）。无支撑体脱出、塌陷、破裂等情况出现。末次随访时,1例患者（2．4％）支撑体轻微移位（〈2mm）,总体植骨融合率为97．6％（40／41）。患者术后融合节段高度及前凸角度较术前有明显提高（P〈0．001）,但术后各时间点之间差异无统计学意义（P〉0．05）。支撑体下沉距离平均为（1．5±1．1）mm,下沉率（下沉距离〉3m）为4．8％。结论：n-HA／PA66支撑体能有效恢复及维持融合节段生理高度及弧度,促进植骨融合,方便术后手术节段的影像学观察,是一种较为理想的颈椎前路支撑植骨材料。