单节段钉棒固定并椎体间融合器融合在腰椎管狭窄并椎间失稳症中的应用

目的 探讨单节段钉棒固定并椎体间融合器融合在治疗腰椎管狭窄并椎间失稳症中的临床疗效.方法 对120例腰椎管狭窄并椎间失稳的病人,施行椎管扩大减压的同时,应用单节段钉棒固定并椎体间融合器融合治疗.结果 术中未发生血管、神经等重要组织结构的损伤,经10个月～5年的随访,术后症状均得到不同程度的改善,无内固定物松动及断裂,所有植骨均达骨性融合,近期和远期疗效均取得了良好的临床效果.结论 单节段钉棒固定并椎体间融合器融合可最大限度地减少脊柱运动节段的丢失,有利于腰椎稳定性重建及脊髓神经功能恢复等优点,在治疗腰椎管狭窄并椎间失稳症中显示出其独特的优势.     

多节段退行性腰椎管狭窄症的手术治疗

目的：探讨多个椎板间潜行式开窗，减压术治疗多节段退行性腰椎管狭窄症的手术特点及疗效，旨在较大限度地保持脊柱的稳定性，预防传统的椎板切除减压手术引起的不良综合症。方法：自1994年至2001年，作者手术治疗多节段腰椎管狭窄症286例。其中127例，55岁以下者，采用 多个椎板间潜行式开窗、减压术。开窗减压最少2处，最多4处。结果：参照陆裕朴疗效标准；本组优89例，良31例，可7例，优良率94．5％。结论：椎板间多窗潜行减压术，治疗多节段退行性腰椎管狭窄症，可达到减压的目的，不良并发症少，但应强调影像学检查与临床症状体征相结合，防止手术范围扩大。手术者要具有熟练的脊柱开窗手术技巧，松解神经根管与防止术后神经根粘连是保证手术效果的关键。     

腰椎管狭窄症后路内镜减压手术策略研究

背景:微创脊柱内镜经椎板间入路(后路内镜)不同椎板开窗减压术已应用于临床治疗腰椎管狭窄症,但尚未对不同后路内镜减压术的临床实用性及最佳适应证进行研究.目的:对比分析经皮后路非全内镜下椎间孔内口减压术(PE-MFD)及全脊柱内镜下椎板开窗减压术(Endo-LOVE)治疗退行性腰椎管狭窄症(DLSS)的临床疗效,并探讨各自...     

下腰椎失稳合并椎管狭窄症的手术治疗

目的：观察下腰椎失稳合并椎管狭窄症患者经椎弓根螺钉系统及椎体融合器治疗的效果。方法：采用后路减压，椎弓根螺钉系统内固定，椎体间融合器BAK融合。结果：术后随访1年一4年3个月(平均2年4个月)，椎体间骨性融合率1年89．6％，2年2个月100％，临床症状消失满意率92％。结论：采用椎管减压、椎弓根螺钉系统加椎间融合器固定，可使滑脱失稳的椎体部分或全部复位，保证脊柱骨性融合，达到脊柱稳定、解除症状的目的。     

退变性腰椎管狭窄症合并腰椎不稳的手术治疗

目的:观察退变性腰椎管狭窄症并腰椎不稳患者经全椎板切除减压,椎弓根螺钉系统及植骨融合治疗效果。方法:采用后路全椎板减压,椎弓根钉系统内固定,横突间植骨融合。结果:术后随访8~30个月椎间骨性融合率1年85％,2年100％,临床症状消失满意率92.3％。结论:采用椎管减压椎弓根螺钉系统加横突间植骨融合,达到脊柱稳定,解除症状的目的。     

全椎板切除减压内固定术治疗退行性腰椎管狭窄症

目的探讨腰椎后路全椎板切除减压,椎间自体植骨,椎弓根螺钉固定治疗退行性腰椎管狭窄症的疗效。方法 2006年3月~2009年7月收治退行性腰椎管狭窄症患者62例,所有患者均行腰椎后路全椎板切除减压,摘除相应节段的椎间盘,椎间植入自体骨,椎弓根螺钉固定减压节段。临床疗效采用JOA评分进行评估。结果 62例患者共减压134节段,固定134节段,所有减压节段均行椎间自体骨植骨。所有患者术后均获随访,平均21.3(15~34)个月。手术疗效根据日本骨科学会(JOA)下腰痛手术疗效标准(15分法)进行评分。62例患者中疗效达到优50例,良9例,可2例,差1例,优良率95.16%。结论腰椎后路全椎板切除减压椎间植骨椎弓根螺钉固定治疗退行性腰椎管狭窄症是一种有效的手术方法。     

腰椎板后移关闭术在老年性腰椎管狭窄症中的临床应用

目的：评价腰椎板切开后移关闭术在治疗老年性腰椎管狭窄症中的临床应用价值。方法：对53例老年单纯退变性腰椎管狭窄患者，使用特制限深椎板骨刀由后路垂直切开椎板，椎管内彻底减压，将椎板后移3～4mm后关闭，使椎管扩大。结果：所有患者腰腿痛症状减轻或消失，随诊44例，随访时间6个月～8年，优良率为89．7％。结论：该手术操作简便快捷，减压彻底，脊柱稳定性好，能有效地预防术后硬膜外纤维瘢痕粘连，是治疗老年性腰椎管狭窄症的一种理想方法。     

经后路减压、椎间融合、复位内固定治疗下腰椎滑脱症

目的评价后路椎板部分切除减压、椎间融合、复位内固定治疗下腰椎滑脱症的临床疗效。方法对32例下腰椎滑脱症患者采用后路椎弓根螺钉椎体撑开提拉复位、椎板部分切除潜行减压、椎管扩大成形、神经根松解、椎间融合器及植骨融合内固定治疗。结果患者均获随访,时间10～48个月,无严重的手术并发症。术后X线复查显示椎间高度均有不同程度的恢复,滑脱椎体完全复位或者基本复位,椎问融合器无明显移位、脱落,椎间融合满意。结论后路减压、椎间融合复位、内固定治疗下腰椎滑脱症复位率高,安全彻底的神经管减压,创伤小,融合满意,疗效确切。     

减压后原位固定融合治疗退变性腰椎管狭窄症

目的 探讨减压后原位固定融合治疗退变性腰椎管狭窄症的方法及疗效.方法 利用后路椎管狭窄节段减压,椎弓根螺钉系统原位固定,自体髂骨椎间植骨治疗52例退变性腰椎管狭窄症.结果 术后随访48例,下肢症状完全缓解者46例(95.83%),腰痛完全缓解者41例(85.42%).随机抽取10例术后1年以上患者行CT三维重建,示椎间植骨均骨性融合.结论 退变性腰椎管狭窄症,减压后原位固定,椎间植骨融合,既可以解除神经根的压迫,又可解决因关节突关节退变而引发的腰痛.     

多节段经椎板间隙椎管扩大术治疗腰椎管狭窄症

目的：探讨多节段经椎板间隙椎管扩大术治疗腰椎管狭窄症的疗效。方法：采用潜式扩大中央椎管和神经根管或摘除椎间盘术式治疗腰椎管狭窄狭窄症共86例，其中2节段减压57例，3节段减压19例，4节段减压10例，术后进行Oswerstry疗效评与影像学观察。结果：术后CT显示椎管直径明显增加，椎管造影显示神经根据管明显扩大。术后1年随访79例，疗效优良率90．1％，术后3随访76例，优良率86．3％，结论：多节段经椎板间隙椎管扩大术操作简单，手术并发症少，中央椎管和神经根管减压充分，对腰椎后柱张力带结构破坏小，治疗腰椎管狭窄症疗效满意。     

PEEK椎间融合器在腰椎滑脱中的应用

目的探讨PEEK椎间融合器加椎弓根内固定技术治疗腰椎滑脱症的临床疗效。方法41例腰椎滑脱患者采用全椎板减压、椎弓根器械复位固定、椎体间放入PEEK融合器植骨融合。结果全部获得随访，时间12～54个月，40例植骨获得椎体间融合，融合时间6～24个月，融合率97．6％。临床疗效按Macnab标准评定：优17例，良21例，可2例，差1例，优良率达92．7％。结论PEEK椎间融合器植骨融合是一种较为实用的融合方式，避免了取自体髂骨带来的问题，在生物力学上保持腰椎生理前凸、提高腰椎生物力学功能，对恢复脊柱稳定性具有积极作用。     

Segmental stability and compressive strength of posterior lumbar interbody fusion implants

STUDY DESIGN: Human cadaveric study on initial segmental stability and compressive strength of posterior lumbar interbody fusion implants. OBJECTIVES: To compare the initial segmental stability and compressive strength of a posterior lumbar interbody fusion construct using a new cortical bone spacer machined from allograft to that of titanium threaded and nonthreaded posterior lumbar interbody fusion cages, tested as stand-alone and with supplemental pedicle screw fixation. SUMMARY OF BACKGROUND DATA: Cages were introduced to overcome the limitations of conventional allografts. Radiodense cage materials impede radiographic assessment of the fusion, however, and may cause stress shielding of the graft. METHODS: Multisegmental specimens were tested intact, with posterior lumbar interbody fusion implants inserted into the L4/L5 interbody space and with supplemental pedicle screw fixation. Three posterior lumbar interbody fusion implant constructs (Ray Threaded Fusion Cage, Contact Fusion Cage, and PLIF Allograft Spacer) were tested nondestructively in axial rotation, flexion-extension, and lateral bending. The implant-specimen constructs then were isolated and compressed to failure. Changes in the neutral zone, range of motion, yield strength, and ultimate compressive strength were analyzed. RESULTS: None of the stand-alone implant constructs reduced the neutral zone. Supplemental pedicle screw fixation decreased the neutral zone in flexion-extension and lateral bending. Stand-alone implant constructs decreased the range of motion in flexion and lateral bending. Differences in the range of motion between stand-alone cage constructs were found in flexion and extension (marginally significant). Supplemental posterior fixation further decreased the range of motion in all loading directions with no differences between implant constructs. The Contact Fusion Cage and PLIF Allograft Spacer constructs had a higher ultimate compressive strength than the Ray Threaded Fusion Cage. CONCLUSIONS: The biomechanical data did not suggest any implant construct to behave superiorly either as a stand-alone or with supplemental posterior fixation. The PLIF Allograph Spacer is biomechanically equivalent to titanium cages but is devoid of the deficiencies associated with other cage technologies. Therefore, the PLIF Allograft Spacer is a valid alternative to conventional cages.     

单节段腰椎退变不稳并神经根管狭窄手术治疗的初步报告

目的 探讨应用腰椎侧后方斜向单枚ＢＡＫ椎间融合器椎间融合及小关节螺钉固定术治疗单节段腰椎退变不稳并神经根和狭窄的治疗效果。方法 采用后路腰椎侧后方对神经根管彻底减压,由侧后方斜向植入单枚ＢＡＫ椎间植骨融合器,再经棘突根部向对侧未减压的小关节植入１枚小关节螺钉固定的方法,治疗单节段腰椎退变不稳并神经根管狭窄患者３０例,男３０例,女１７例,平均年龄４６．５岁;其中融合节段为Ｌ３～４者４例,Ｌ４－５者１     

应用椎间融合器治疗下腰疾患的临床研究

目的总结应用椎间融合器结合或不结合附加内固定方法治疗下腰椎疾患的效果。方法对 12 6例下腰椎疾患的患者进行手术治疗 ,单纯应用椎间融合器 6例 ,椎间融合器加内固定 12 0例。结果全部患者均安全完成手术 ,未出现神经系统并发症 ,平均随访 39.7个月 (2 4～ 6 0个月 ) ,2年以上随访临床疗效优良率均在 90 %以上。结论采用椎间融合器结合或不结合附加内固定方法 ,可在充分减压的前提下 ,保持脊柱的稳定性 ,同时完成植骨融合 ,长期随访临床效果肯定。     

Motion of threaded cages in posterior lumbar interbody fusion

A high rate of pseudarthrosis and a high overall rate of implant migration requiring surgical revision has been reported following posterior lumbar interbody fusion using BAK threaded cages. The high rate of both pseudarthrosis and implant migration may be due to poor fixation of the implant. The purpose of this study was to analyse the motion of threaded cages in posterior lumbar interbody fusion. Six cadaveric human lumbar spine segments (three L2/3 and three L4/5 segments) were prepared for biomechanical testing. The segments were tested, without preload, under forces of axial compression (600 N), torsion (25 Nm) and shearing force (250 N). The tests were performed first with the segments in an intact state, and subsequently following instrumented stabilisation with two BAK cages via a posterior approach. These results were compared with those of a finite element model simulating the effects of identical forces on the segments with constructs. As the results were comparable, the finite element model was used for analysing the motion of BAK cages within the disc space. Motion of the implants was not seen in compression. In torsion, a rolling motion was noted, with a range of motion of 10.6° around the central axis of the implant when left/right torsion (25 Nm) was applied. The way the implants move within the segment may be due to their special shape: the thread of the implants can not prevent the BAK cages rolling within the disc space. Received: 10 July 1999 Revised: 6 April 2000 Accepted: 19 April 2000     

经后路PLIF加BIOFLEX治疗腰椎失稳症

目的 探讨经后路植入椎体间可撑开螺文融合器PLIF及弹性椎弓根内固定系统BIOFLEX对腰椎失稳定症治疗的临床效果.方法 对132例腰椎失稳症患者采用后路椎管及神经根管减压,BIOFLEX椎弓根系统固定并椎间植入PLIF手术治疗.结果 132例术后随访8～23个月,平均15个月,未发现椎间植骨不融合情总,术后优良率97.7%.结论 经后路植入椎体间传统椎间融合术的许多不足,大大减少了术后并发症,提高了腰椎失稳症的治疗效果.     

颈椎椎体融合器的临床应用（附135例报告）

目的：观察比较3种颈椎椎体间融合器前路减压后椎体间融合的固定及融合效果。方法：采用BAK、CHTF和InterFix3种颈椎椎体间融合器行颈椎病及颈椎间盘突出症前路减压后椎体间融合135例,其中BAK 65例,CHTF42例,InterFix技术28例。术后颈椎X线片及CT检查,观察手术椎节的稳定性和融合情况。结果：随访8－31月,施术节段稳定,3种颈椎椎体间融合器固定融合率无显著差异。结论：颈椎椎体间固定融合技术使施术椎节立即稳定,避免了自体植骨引起的并发症,可作为替代传统颈前路椎体间植骨融合术的方法之一。     

Posterior lumbar interbody fusion (PLIF) with cages and local bone graft in the treatment of spinal stenosis

Posterior lumbar interbody fusion (PLIF) implants are increasingly being used for 360 degrees fusion after decompression of lumbar spinal stenosis combined with degenerative instability. Both titanium and PEEK (PolyEtherEtherKetone) implants are commonly used. Assessing the clinical and radiological results as well as typical complications, such as migration of the cages, is important. In addition, questions such as which radiological parameters can be used to assess successful fusion, and whether the exclusive use of local bone graft is sufficient, are frequently debated. We prospectively evaluated 30 patients after PLIF instrumentation for degenerative lumbar spinal canal stenosis, over a course of 42 months. In all cases, titanium cages and local bone graft were used for spondylodesis. The follow-up protocol of these 30 cases included standardised clinical and radiological evaluation at 3, 6, 12 and 42 months after surgery. Overall satisfactory results were achieved. With one exception, a stable result was achieved with restoration of the intervertebral space in the anterior column. After 42 months of follow-up in most cases, a radiologically visible loss of disc space height can be demonstrated. Clinically relevant migration of the cage in the dorsal direction was detected in one case. Based on our experience, posterior lumbar interbody fusion (PLIF) can be recommended for the treatment of monosegmental and bisegmental spinal stenosis, with or without segmental instability. Postoperative evaluation is mainly based on clinical parameters since the titanium implant affects the diagnostic value of imaging studies and is responsible for artefacts. The results observed in our group of patients suggest that local autologous bone graft procured from the posterior elements after decompression is an adequate material for bone grafting in this procedure.     

退变性腰椎侧凸的外科治疗

目的探讨退变性腰椎侧凸的特点、诊断与治疗。方法2001年7月至2004年1月手术治疗退变性脊柱侧凸患者15例,行后路彻底椎板减压、椎弓根钉棒矫形固定,椎间融合器融合12例,后外侧植骨融合3例,回顾性分析其临床特点、手术方法与效果。结果术后侧凸平均矫正率为42.8%,腰腿痛均消失,下肢麻木等症状减轻,随访6~36个月,植骨融合良好,无融合器移位,矫正度数与椎间隙高度无丢失。结论成人退变性腰椎侧凸发病年龄大,多合并腰椎管狭窄、失稳等,腰腿痛原因复杂,治疗的主要目的是彻底减压,通过矫形使脊柱重新获得稳定,椎弓根钉棒固定及椎间融合是有效的治疗方法。     

微创手术治疗单节段腰椎管狭窄症的疗效评价

目的:对比微创手术与传统开放手术治疗单节段腰椎管狭窄症的临床效果,评价微创手术治疗腰椎管狭窄症的安全性和有效性。方法:2008年1月～2009年1月收治43例单节段腰椎管狭窄症患者,其中28例采用传统开放减压、后路椎体间融合手术(posterior interbody fusion,PLIF)治疗(A组),15例采用微创减压、经椎间孔融合手术(transforaminal lumbar interbody fusion,TLIF)治疗(B组),比较两组患者的手术时间、术中C型臂X线机照射时间、术中出血量、术后引流量、术后下地时间和术后平均住院时间,并分别采用Oswestrydisability index(ODI)、visual analogue scores(VAS)和X线评价治疗效果。结果:所有患者均获得随访,两组术前一般资料、VAS和ODI评分无显著性差异。B组手术时间和术中透视时间多于A组(P<0.01),而术中出血量和术后引流量B组明显低于A组(P<0.01),术后下地活动时间和术后平均住院日B组明显短于A组(P<0.01)。术后5d时VAS评分B组优于A组(P<0.05),而其他时间相比两组VAS评分与ODI评分相比均无显著性差异(P>0.05),术后X线评价融合率两组亦无显著性差异(P>0.05)。结论:与传统开放手术相比,微创手术治疗单节段腰椎管狭窄症,同样可以获得安全、有效的治疗结果,并且在手术出血量、术后引流量、术后下地活动时间和术后住院时间方面优于传统开放手术。