两种不同材料椎间融合器治疗腰椎不稳症的应用比较*

背景：碳纤维箱型和钛合金螺纹状椎间融合器是两种材料及形状均不同的椎间融合器，均取得了良好的临床效果。 目的： 应用碳纤维箱型及钛合金螺纹状Cage联合椎弓根内固定系统治疗腰椎不稳症，比较影像学变化及临床症状改善情况。 方法：对59例行后路短节段椎弓根钉系统复位与内固定单节段腰椎不稳症患者进行随访，其中实施碳纤维楔型椎间融合器37例，钛合金螺纹状椎间融合器22例。用M-JOA评分的症状改善率评价患者治疗效果；术前、术后1周及1年摄X射线片及CT，观察椎体间高度、融合节段前凸弧度及植骨融合情况。 结果与结论：术后1周，碳纤维箱型Cage组术后的椎体间高度及腰椎前凸弧度的恢复值与钛合金螺纹状Cage组差异无显著性意义(P > 0.05)；术后1年，碳纤维箱型Cage组椎体间高度及腰椎前凸弧度的恢复值高于钛合金螺纹状Cage组(P < 0.01)。两组患者术后1年均获得骨性融合，临床症状缓解良好，下腰痛症状改善率差异无显著性意义(P > 0.05)。结果表明，应用碳纤维箱型Cage与钛合金螺纹状Cage行椎间融合联合椎弓根内固定系统治疗腰椎不稳症，二者在缓解下腰部疼痛及植骨融合方面效果显著，但碳纤维箱型Cage行椎间融合联合椎弓根内固定系统行后路腰椎融合术可以维持较好的椎体间高度及腰椎前凸弧度。 关键词：椎间融合术；椎间融合器；腰椎不稳症；内固定系统；碳纤维箱型Cage；钛合金螺纹状Cage

Rectangle carbon fiber versus threaded titanium cage in the treatment of lumbar spinal instability

BACKGROUND: A variety of cages, such as carbon fiber cage and threaded titanium cage, for lumbar fusion have been used to treat lumbar spinal instability and obtain favorable clinical outcomes. OBJECTIVE: To treat lumbar spinal instability using rectangle carbon fiber cage and threaded titanium cage and compare the clinical effect and radiological appraisal. METHODS: A total of 59 cases of lumbar spinal instability underwent posterior lumbar interbody fusion with rectangle carbon fiber cage (n=37) and threaded titanium cage (n=22) combined pedical fixation were analyzed retrospectively. All patients were evaluated by M-JOA scoring system, and the intervertebral height and the lumbar triangle were observed. The bone fusion was determined on X-ray and CT at follow-up. RESULTS AND CONCLUSION: No differences were observed between two groups in intervertebral height and the lumbar triangle at 1 week postoperatively (P > 0.05). At 1 year postoperatively, the height of intervertebral space and the lumbar triangle were greater 1 year after operation in fusion with rectangle carbon fiber cage compared with fusion with threaded titanium cage (P < 0.01). Both groups obtained bony fusion, with clinical symptoms relief and lower back pain improvement (P > 0.05). The rectangle carbon fiber cage and threaded titanium cage in interbody lumbar fusion are effective to treat lumbar spinal instability in clinical effect and bone fusion, but the interbody fusion with rectangle carbon fiber cage could maintain a perfect height of intervertebral space and lumbar triangle.