腰椎退行性病单独腰椎斜外侧椎体间融合术的并发症

[目的]探究单独腰椎斜外侧入路椎体间融合术(单独OLIF)的早期并发症。[方法]回顾性研究自2017年8月～2018年12月在本院应用单独OLIF技术治疗腰椎退行性疾病96例患者,男44例,女52例;年龄33岁-86岁。记录术中和术后并发症,采用视觉模拟疼痛评分(VAS)、Oswestry功能障碍指数(ODI)评价临床疗效,行影像学检查以确定内置物位置、终板损伤和对侧神经根等情况。[结果] 96例患者共进行了137个节段的单独OLIF手术,手术时间平均(94.10±25.95) min,术中平均出血量(48. 41±9.97) ml,术后平均住院天数(6.01±2.51) d。所有患者术中术后均未输血。术中共发生血管损伤2例,终板损伤3例,腹膜损伤1例,术中及时处理,术后恢复良好,无不良后果;30例患者出现术后并发症,并发症发生率为31.25%,其中4例患者出现了两种并发症。术后并发症包括交感神经损伤2例,对侧神经根损伤2例,股四头肌无力3例,髂腰肌无力1例,大腿前外侧疼痛3例,融合器下沉15例,融合器移位1例,融合节段椎体骨折2例,腹壁皮下积气1例。经相应处理,以上并发症均未导致严重不良后果。术后所有患者腰腿疼痛明显减轻,下肢功能明显好转。末次随访时,96例患者的腰痛、腿痛VAS评分和ODI评分均较术前显著下降,差异具有统计学意义(P<0.05)。[结论]单独OLIF技术仍在发展的早期,手术并发症需要引起高度关注,但短期随访的结果是令人满意的。     

腰椎斜外侧椎间融合术后融合器沉降的原因分析

目的:观察斜外侧椎间融合(oblique lateral interbody fusion,OLIF)治疗腰椎病变术后融合器沉降现象,总结融合器沉降特点,并分析其原因,提出预防性措施。方法:回顾性分析2015年10月至2018年12月收治的144例腰椎病变资料,其中男43例,女101例;年龄20~81(60.90±10.06)岁;腰椎间盘退行性病变17例,巨大型腰椎间盘突出12例,椎间盘源性腰痛5例,腰椎管狭窄症33例,腰椎退行性滑脱26例,腰椎椎弓峡部裂伴椎体滑脱28例,腰椎内固定术后邻椎病11例,炎症转归期原发性椎间隙炎7例,腰椎退行性侧后凸5例。术前双能X线骨密度检查提示存在骨量减少或骨质疏松57例,骨密度正常87例。融合节段数:单节段124例,2节段11例,3节段8例,4节段1例。采用Stand-alone OLIF 40例,OLIF联合后路椎弓根螺钉固定104例。记录术后融合器沉降的发生情况,对可能风险因素进行单因素分析,观察融合器沉降对于临床结果的影响。结果:所有手术顺利完成,手术时间中位数99 min,术中出血量中位数106 ml;术中发生终板损伤30例,合并椎体骨折5例。所有患者获得随访,时间6~30(14.57±7.14)个月。随访过程中除原发性腰椎间隙炎病例、部分腰椎椎弓峡部裂伴椎体滑脱病例,其余出现不同程度的融合器沉降现象,其中正常沉降119例,异常沉降25例(Ⅰ级23例,Ⅱ级2例)。未出现椎弓根螺钉系统松动或断裂现象,椎间隙高度由术前的(9.48±1.84) mm恢复至术后3~5 d的(12.65±2.03) mm及末次随访时的 (10.51±1.81) mm,术后3~5 d与术前比较、末次随访与术后3~5 d比较差异均有统计学意义(P<0.05)。椎间融合率为94.4%(136/144)。腰痛和腿痛视觉模拟评分(visual analogue scale,VAS)分别由术前的(6.55±2.29)、(4.72±1.49)分降低至末次随访时的(1.40±0.82)、(0.60±0.03)分(P<0.000 1);ODI由术前的(38.50±6.98)%恢复至末次随访时的(11.30±3.27)%(P<0.05)。并发症发生率为31.3%(45/144),再手术率9.72%(14/144),其中因融合器沉降或移位而再次手术8例,占再手术的57.14%(8/14)。单因素分析结果显示:在骨量减少或骨质疏松组、Stand-alone OLIF组、2节段或以上融合组、终板损伤组中其异常沉降例数分别高于骨量正常组、OLIF联合椎弓根螺钉固定组、单节段融合组、终板无损伤组。结论:融合器沉降是OLIF术后较为常见的现象,术前骨量减少或骨质疏松、Stand-alone OLIF应用、2节段或以上融合和术中终板损伤可能是术后融合器沉降的重要因素。虽然融合器沉降程度与临床症状无明显相关,但存在融合器移位的风险,需要加强预防,以降低因融合器沉降而带来的严重并发症,包括再手术。     

单纯斜外侧腰椎椎间融合术后融合器沉降与腰椎矢状面参数的关系

目的:探讨单纯斜外侧腰椎椎间融合术(oblique lumbar interbody fusion,OLIF)术后融合器沉降与腰椎矢状面参数之间的关系.方法:回顾性分析117例接受单节段OLIF手术(无内固定)患者的临床资料,根据椎间隙高度(disc height,DH)下降程度分为融合器0级沉降组(0～24％)、Ⅰ级...     

斜外侧椎间融合术融合器沉降对腰椎生物力学影响的有限元分析

目的:应用三维有限元法分析椎间融合器(cage)沉降对斜外侧椎间融合术(oblique lateral interbody fusion,OLIF)术后腰椎生物力学的影响.方法:根据1例健康成年人腰椎CT扫描数据构建正常腰椎L3～L5节段三维有限元模型,模拟进行L4/5节段OLIF手术,根据cage沉降陷入椎体程度(0...     

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。     

斜外侧腰椎椎体间融合治疗腰椎退行性疾病的疗效及术后融合器沉降情况

目的 探讨斜外侧腰椎椎体间融合(OLIF)治疗腰椎退行性疾病的疗效,观察术后融合器沉降发生情况.方法 采用OLIF治疗109例腰椎退行性疾病患者.手术前后采用疼痛VAS评分、Oswestry功能障碍指数(ODI)评分评估疗效,根据术后影像学资料判定是否有融合器沉降情况.结果 患者均获得随访,时间13～39个月.术后患者...     

Healing properties of allograft from alendronate-treated animal in lumbar spine interbody cage fusion

This study investigated the healing potential of allograft from bisphosphonate-treated animals in anterior lumbar spine interbody fusion. Three levels of anterior lumbar interbody fusion with Brantigan cages were performed in two groups of five landrace pigs. Empty Brantigan cages or cages filled with either autograft or allograft were located randomly at different levels. The allograft materials for the treatment group were taken from the pigs that had been fed with alendronate, 10 mg daily for 3 months. The histological fusion rate was 2/5 in alendronate-treated allograft and 3/5 in non-treated allograft. The mean bone volume was 39% and 37.2% in alendronate-treated or non-treated allograft (NS), respectively. No statistical difference was found between the same grafted cage comparing two groups. The histological fusion rate was 7/10 in all autograft cage levels and 5/10 in combined allograft cage levels. No fusion was found at all in empty cage levels. With the numbers available, no statistically significant difference was found in histological fusion between autograft and allograft applications. There was a significant difference of mean bone volume between autograft (49.2%) and empty cage (27.5%) (P<0.01). In conclusion, this study did not demonstrate different healing properties of alendronate-treated and non-treated allograft for anterior lumbar interbody fusion in pigs.     

单纯斜外侧腰椎间融合术后融合器下沉的危险因素及其对临床疗效的影响

【摘要】 目的：探讨单纯斜外侧腰椎间融合术（stand-alone-oblique lateral interbody fusion,SA-OLIF）治疗退变性腰椎疾病术后融合器下沉的危险因素及其对临床疗效的影响。方法：回顾性分析2018年1月～2021年10月在我院行SA-OLIF手术治疗的89例腰椎退变性疾病患者的临床资料。收集患者的一般资料[年龄、性别、体重指数（body mass index,BMI）、吸烟状况、激素使用情况、疾病类型以及是否合并骨质疏松]和手术相关资料[手术时间、术中出血量、手术节段、融合节段数、融合器高度],在腰椎正侧位及脊柱全长X线片上测量患者术前、术后1周手术融合节段椎间隙高度（disc height,DH）、腰椎前凸角（lumbar lordosis,LL）,计算矫正值。术前和术后3个月、6个月、1年时进行Oswestry功能障碍指数（Oswestry disability index,ODI）评定及腰腿痛视觉模拟评分（visual analogue scale,VAS）。根据患者术后1年手术节段椎间隙高度丢失值将患者分为两组：DH丢失值≥2mm为下沉组（17例）;DH丢失值＜2mm为未下沉组（72例）。对可能影响融合器下沉的因素进行单因素统计分析及多因素logistic回归分析,确定SA-OLIF术后患者融合器下沉的危险因素及对临床疗效的影响。结果：两组患者的年龄、合并骨质疏松、融合器高度、术后1周DH、矫正DH等资料有统计学差异（P＜0.05）。Logistic回归分析结果显示年龄（OR＝2.889,95%CI：1.807,4.979）、合并骨质疏松（OR＝3.753,95%CI:1.926,15.210）、术后1周DH（OR＝2.777,95%CI：1.155,3.903）、矫正DH（OR＝1.965,95%CI：1.523,4.334）为腰椎退行性变行SA-OLIF手术后融合器下沉的独立危险因素。两组间术前及术后3个月、6个月及1年时VAS评分及ODI的差异均无统计学意义（P＞0.05）。结论：年龄大、骨质疏松严重、术中矫正DH大会增加融合器下沉风险;融合器下沉对SA-OLIF术后1年内的临床疗效无明显影响。     

Anterior lumbar interbody fusion (ALIF) using a cage with stabilization

AIM: The authors have conducted a prospective observational study to evaluate the clinical and radiological outcome and complications associated with anterior lumbar interbody fusion (ALIF) using a cage with stabilization. MATERIALS AND METHODS: Eighteen patients ranged in age from 36 to 77 years (mean 53 years) who had undergone ALIF were prospectively evaluated. Clinical outcome was graded using a modified Prolo scale (economic, pain, medication) and radiological outcome was recorded (X-rays). RESULTS: Based on Prolo scale scores, excellent or good outcomes were achieved in 61 % of these patients (75 % mono-segmental degenerative disc disease: n = 8; and 50 % after failed-back surgery syndrome: n = 10). The mean follow-up was 14 months (from 12 to 18 months) after surgery. Postoperative X-rays demonstrated solid arthrodesis for 12 (66 %) of the 18 patients. Complications requiring repeated surgery included one case of postoperative peritonitis without infection of the cage. We found one deep-vein thrombosis. There were four cases with postoperative meralgia paresthetica. On routine follow-up radiography one cage was found to be dislocated (2 mm) and in one case we found two broken screws. CONCLUSION: The ALIF cage with stabilization is one possible therapy option for treatment of mono-segmental degenerative disc disease and failed-back surgery after unsuccessful conservative therapy. However, the clinical results should be interpreted with caution.     

Pivox固定系统在斜外侧腰椎椎间融合术治疗单节段腰椎疾患中的临床应用

【摘要】 目的：探讨Pivox固定系统在斜外侧腰椎椎间融合术（oblique lateral interbody fusion,OLIF）治疗单节段腰椎疾患中的应用及临床疗效。方法：自2020年5月～2021年1月,收集我院采用单纯OLIF（不行后路椎弓根螺钉固定技术）治疗单节段腰椎疾患（盘源性腰痛、腰椎滑脱、腰椎管狭窄）的患者资料,其中男36例,女33例;年龄32～79岁,平均59.1±5.9岁。分为单纯OLIF组（39例）和Pivox+OLIF组（30例）,评估两组的围手术期指标：包括切口长度,手术时间,术中出血量,住院时间;在术前、术后1周、1个月、3个月、6个月、12个月时用疼痛视觉模拟评分（visual analogue scale,VAS）和Oswestry功能障碍指数（Oswestry disability index,ODI）对两组临床疗效进行评价,评估并比较两组患者手术前后的椎间隙高度、椎间孔纵径和面积以及术后腰椎融合情况。以及比较两组之间并发症情况。结果：所有患者随访12～18个月,平均14.0±0.3个月,两组之间性别、年龄、疾病类型、手术节段、骨密度、体质指数（body mass index,BMI）等方面比较差异均无统计学意义（P>0.05）。Pivox+OLIF组手术时间大于OLIF组（P<0.05）,而两组之间切口长度、出院时间、术中出血量无统计学差异（P>0.05）。两组组内围手术期VAS评分、ODI比较均为术前高于术后1周及术后1、3、6、12个月（P<0.05）,术后1周及术后1、3、6、12个月时,两组之间VAS评分、ODI比较无统计学差异（P>0.05）。两组组内椎间隙高度、椎间孔纵径和面积术后1周及术后6、12个月较术前均明显增加（P<0.05）,术后1周及术后6、12个月时,Pivox+OLIF组椎间隙、椎间孔纵径和面积增加值均大于OLIF组,但无统计学差异（P>0.05）。两组均有融合器沉降病例,OLIF组有两例发生融合器移位,Pivox+OLIF组无一例融合器移位,两组之间融合率和并发症发生率无明显差异（P>0.05）。结论：Pivox+OLIF技术治疗单节段腰椎退行性疾病的近期疗效满意,但相对于单纯OLIF,Pivox+OLIF在椎管减压以及融合器下沉方面并无明显优势。     

经椎间孔腰椎椎体间融合联合单侧椎弓根钉棒固定术后融合器沉降及其对临床疗效的影响

目的 :观察经椎间孔腰椎椎体间融合(transforaminal lumbar interbody fusion,TLIF)联合单侧椎弓根钉棒内固定术后融合器沉降情况及其与临床疗效的相关性。方法:回顾分析2014年1月～2015年1月行TLIF+单侧椎弓根钉棒内固定术的43例退变性腰椎疾病患者,融合节段数51个。随访时间23.8±3.7个月(19～28个月)。通过腰椎CT测量并比较患者术前及术后融合节段椎间高度的变化,测量时间点分别为术前、术后即刻、术后半年、术后1年及末次随访时。根据椎间高度丢失的程度将融合器沉降分为0级(0～24%)、Ⅰ级(25%～49%)、Ⅱ级(50%～74%)和Ⅲ级(75%～100%)。统计、分析总体融合器沉降度在术后半年、1年及末次随访时的变化情况。根据融合器前后径及融合节段的长度,分别将患者分为32mm组(n=15)、36mm组(n=28)及单节段组(n=35)、双节段组(n=8),分析各组间术后半年、术后1年及末次随访时融合器沉降度是否存在统计学差异。统计43例患者术前和术后半年、1年及末次随访时的VAS评分及Oswestry功能障碍指数(Oswestry disability index,ODI),采用Pearson系数分析末次随访时融合器沉降与VAS评分、ODI的相关性。结果 :末次随访时88.2%(45/51)的融合节段融合器沉降等级为0级,11.8%(6/51)的融合节段沉降等级为Ⅰ级,无Ⅱ级或Ⅲ级沉降的患者。术后半年融合器沉降程度[(9.6±3.4)%]与术后1年融合器沉降程度[(14.2±5.6)%]比较有统计学差异(P0.05),而术后1年与末次随访时的融合器沉降程度无统计学差异(P0.05)。术后1年及末次随访时32mm组患者的融合器沉降程度大于36mm组(P0.05),单节段组和双节段组的融合器沉降程度无统计学差异(P0.05)。术后半年、1年及末次随访时腰腿痛VAS评分与术前比较显著降低(P0.05),ODI明显改善(P0.05)。末次随访时的腰痛VAS评分与融合器的沉降程度呈弱相关性(Pearson相关系数为0.334,P0.05),而腿痛VAS评分及ODI与融合器沉降无明显相关性(P0.05)。结论:TLIF联合单侧椎弓根钉棒内固定术后融合器沉降的程度低,且多数发生在术后1年内。在条件允许的情况下尽量选择前后径大的融合器以降低融合器沉降度,而手术节段的长短(单节段或双节段)对融合器沉降无明显影响。腰痛VAS评分与融合器沉降度存在弱相关性。     

腰椎后路椎间融合术后椎间融合的X线片及三维CT评价

目的 探讨X线片和三维CT(3D-CT)在判定单节段后路腰椎椎间融合术后椎间融合情况的临床价值.方法 选取接受后路腰椎椎间融合术并随访1年以上的患者43例,男19例,女24例;年龄16～74岁,平均47.2岁.峡部裂性滑脱21例,退变性滑脱15例,腰椎间盘突出并不稳症3例,腰椎间盘突出症复发3例,极外侧椎间盘突出症1例.单纯骨粒植骨26例,骨粒加椎间融合器17例.单节段内固定24例,双节段内固定19例.均为单节段椎间融合,其中L_(3,4) 6例,L_(4,5),17例,L_5S_1 20例.应用改良Brantigan评分判定腰椎正侧位X线片及3D-CT扫描所示椎间融合程度;动力位X线片判断椎间稳定性.结果 随访12～85个月,平均18个月.末次随访时X线片及3D-CT所示椎间融合率分别为64%(28/43例)和40%(17/43例).3D-CT的Brantigan评分小于正侧位X线片(P<0.05).根据诊断、固定节段及融合方式不同分组,各组3D-CT评分均低于正侧位X线片(P<0.05).动力位X线片示椎间不稳定者仅3例(7%).结论 腰椎3D-CT能更准确地评价椎间融合情况.拆除内固定前进行3D-CT检查非常必要.拆除内固定前摄动力位X线片对判定椎体间融合的临床意义不大.     

单侧椎弓根钉固定结合单枚融合器治疗腰椎不稳症

目的：探讨经椎间孔入路单侧椎弓根钉固定结合单枚融合器治疗腰椎不稳症的临床疗效。方法：回顾性分析2009年至2012年收治且获得8个月以上随访腰椎不稳症50例,均有顽固性或反复下腰痛,有单侧或单侧为主的下肢放射痛,X线片及CT片显示腰椎不稳。采用经椎间孔入路单枚融合器椎间融合,结合单侧或双侧椎弓根钉固定治疗。根据固定方法不同,分为单侧固定组和双侧固定组。单侧固定组20例22间隙,男8例,女12例;年龄26-66岁;峡部裂性Ⅰ度滑脱2例,退行性滑脱8例,腰椎间盘突出症10例;融合部位L3,41例,L4,512例,L5S19例。双侧固定组30例30间隙,男14例,女16例;年龄41-62岁;峡部裂型Ⅰ度滑脱4例,退行性滑脱14例,腰椎间盘突出症12例;融合部位L3,43例,L4,515例,L5S112例。分析两组患者的手术时间、术中出血量、术后引流量、并发症情况,并对其椎间隙高度、前凸角的变化、融合率及临床疗效等进行比较。结果：两组患者术后切口均Ⅰ期愈合,腰痛基本消失,下肢放射痛均消失,无感染、硬脊膜损伤等发生。单侧固定组术后无医源性神经症状,双侧固定组术后1例足下垂。所有患者获得随访,时间8-18个月,平均（10.8±4.3）个月。临床疗效按照JOA评分好转率（RIS）评定,两组均获得较好临床疗效,且两组融合率比较差异无统计学意义,两种内固定治疗方法均能有效增加病变椎间隙高度。单侧固定组较双侧固定组手术时间更短,术中出血和术后引流量更少。结论：只要严格掌握手术适应证,注意手术操作技巧,经椎间孔入路单枚融合器加单侧椎弓根钉治疗腰椎不稳症具有创伤小、出血少、恢复快、经济实用等优点。     

Anterior lumbar interbody fusion with carbon fiber cage loaded with bioceramics and platelet-rich plasma. An experimental study on pigs

Platelet-rich plasma (PRP) is an autogenous source of growth factor and has been shown to enhance bone healing both in clinical and experimental studies. PRP in combination with porous hydroxyapatite has been shown to increase the bone ingrowth in a bone chamber rat model. The present study investigated whether the combination of beta tricalcium phosphate (-TCP) and PRP may enhance spinal fusion in a controlled animal study. Ten Danish Landrace pigs were used as a spinal fusion model. Immediately prior to the surgery, 55 ml blood was collected from each pig for processing PRP. Three-level anterior lumbar interbody fusion was performed with carbon fiber cages and staples on each pig. Autogenous bone graft, -TCP, and -TCP loaded with PRP were randomly assigned to each level. Pigs were killed at the end of the third month. Fusion was evaluated by radiographs, CT scanning, and histomorphometric analysis. All ten pigs survived the surgery. Platelet concentration increased 4.4-fold after processing. Radiograph examination showed 70% (7/10) fusion rate in the autograft level. All the levels with -TCP+PRP showed partial fusion, while -TCP alone levels had six partial fusions and four non-fusions (P=0.08). CT evaluation of fusion rate demonstrated fusion in 50% (5/10) of the autograft levels. Only partial fusion was seen at -TCP levels and -TCP+PRP levels. Histomorphometric evaluation found no difference between -TCP and -TCP+PRP levels on new bone volume, remaining -TCP particles, and bone marrow and fibrous tissue volume, while the same parameters differ significantly when compared with autogenous bone graft levels. We concluded from our results in pigs that the PRP of the concentration we used did not improve the bone-forming capacity of -TCP biomaterial in anterior spine fusion. Both -TCP and -TCP+PRP had poorer radiological and histological outcomes than that of autograft after 3 months.     

骨密度对斜侧方入路椎体间融合术治疗腰椎退行性滑脱症疗效的影响

【摘要】 目的：分析骨密度对斜侧方入路椎体间融合术（oblique lateral interbody fusion,OLIF）治疗腰椎退行性滑脱症疗效的影响。方法：回顾性分析2017年12月~2020年7月期间我科在脊柱微创通道系统辅助下OLIF治疗的Meyerding Ⅰ级腰椎退行性滑脱症患者的临床资料。根据患者术前骨密度分为低骨量组（-2.5相似文献   

Fusion and subsidence rate of stand alone anterior lumbar interbody fusion using PEEK cage with recombinant human bone morphogenetic protein-2

Introduction

Anterior lumbar interbody fusion (ALIF) is an established treatment for structural instability associated with symptomatic disk degeneration (SDD). Stand-alone ALIF offers many advantages, however, it may increase the risk of non-union. Recombinant human bone morphogenetic protein-2 (BMP-2) may enhance fusion rate but is associated with postoperative complication. The optimal dose of BMP-2 remains unclear. This study assessed the fusion and subsidence rates of stand-alone ALIF using the SynFix-LR interbody cage with 6 ml/level of BMP-2.

Methods

Thirty-two ALIF procedures were performed by a single surgeon in 25 patients. Twenty-five procedures were performed for SDD without spondylolisthesis (SDD group) and seven procedures were performed for SDD with grade-I olisthesis (SDD-olisthesis group). Patients were followed-up for a mean of 17 ± 6 months.

Results

Solid fusion was achieved in 29 cases (90.6 %) within 6 months postoperatively. Five cases of implant subsidence were observed (16 %). Four of these occurred in the SDD-olisthesis group and one occurred in the SDD group (57 % vs. 4 % respectively; p = 0.004). Three cases of subsidence failed to fuse and required revision. The body mass index of patients with olisthesis who developed subsidence was higher than those who did not develop subsidence (29 ± 2.6 vs. 22 ± 6.5 respectively; p = 0.04). No BMP-2 related complications occurred.

Conclusion

The overall fusion rate of stand-alone ALIF using the SynFix-LR system with BMP-2 was 90.6 %, comparable with other published series. No BMP-2 related complication occurred at a dose of 6 mg/level. Degenerative spondylolisthesis and obesity seemed to increase the rate of implant subsidence, and thus we believe that adding posterior fusion for these cases should be considered.     

PLIF治疗腰椎节段性不稳定

目的探讨应用PLIF治疗腰椎节段性不稳定的适应性。方法 2002-12-2010-10我院采用PLIF技术治疗腰椎节段性不稳定患者30例,男19例,女11例,年龄24～69岁,平均45.8岁。失稳节段:L3-46例,L4-511例,L5-S113例。3种椎间融合术包括:单纯椎体间植骨、双侧椎体间融合器、单侧斜行椎间融合器,术中均采用椎弓根固定系统辅助,后2种方法中在安放内置物的同时,均辅以椎间自体骨粒植骨。临床恢复情况按Nakai分级;疗效评定按照目测视觉类比评分法(visualanalogue scale VAS)。结果随访3个月～6年9个月,平均3年7个月。术后18个月时按Nakai标准评定:优19例,良9例,可2例;优良率93.3%。患者的腰痛、下肢疼痛症状均有明显缓解,绝大多数患者恢复正常的工作和生活。结论 PLIF手术是治疗腰椎节段性不稳定比较可靠的方法,只要把握手术适应证,可以取得满意的结果。