Prospace融合器结合关节突融合在单节段经后路腰椎间融合术中的初步应用

目的评价Prospace融合器结合自体骨关节突融合技术应用于单节段经后路腰椎间融合术(posterior lumbar interbody fusion,PLIF)中的效果。方法 2002年5月~2004年12月,收治76例脊柱疾患。其中男52例,女24例;年龄23~81岁,平均53.2岁。退变性腰椎间盘病60例,腰椎峡部裂9例,翻修手术7例。病程1.2~8.7年,平均3.6年。实施PLIF的节段:L2、32例,L3、47例,L4、554例, L5~S110例,L4~S11例,L5、62例。减压后双侧植入Prospace融合器,并将椎板减压所得自体骨填塞于融合器之间及其周围椎间隙内,结合椎弓根螺钉系统,将剩余自体骨填塞在双侧关节突关节。JOA评分评估临床疗效,腰椎侧位X线片测量椎间隙高度比和腰椎前凸角,CT扫描示有骨小梁通过椎间隙、关节突关节、腰椎动态侧位X线片无椎间活动、内植物周围无透亮间隙则评定为融合。结果平均手术出血量和手术时间分别为384 ml和178 min。获随访24~43个月,平均32个月。随访末期JOA评分为26.1±2.7,高于术前评分(14.5±4.0),且差异有统计学意义(P<0.05);平均JOA恢复率为81.1%(37.5%~100.0%);椎体融合率为97.4%(74/76)。平均椎间隙高度比和融合节段腰椎前凸角分别由术前的0.27±0.07、5.8±2.2°,改善为随访末期的0.33±0.06、11.3±2.0°,差异均有统计学意义(P<0.05)。无明显与内植物相关的并发症发生。结论若手术指征选择恰当,Prospace应用于单节段PLIF可获得满意的临床和影像学效果,且安全有效。

Preliminary Application of One-level Posterior Lumbar Interbody Fusion with Prospace and Facet Fusion Using Local Autograft

OBJECTIVE: To evaluate the safety and efficacy of one-level posterior lumbar interbody fusion (PLIF) combined with Prospace and facet fusion using local autograft. METHODS: Clinical and radiographic data of 76 patients treated by this technique was reviewed from May 2002 to December 2004. Of them, there were 52 males and 24 females, with an average age of 53.2 years (23-81 years), including 60 cases of degenerative disc disease, 9 cases of failed back surgery syndrome and 3 cases of spondylolysis.The disese courses were 1.2-8.7 years (mean 3.6 years). The levels of PLIF were: L2,3 in 2 cases, L3,4 in 7, L4,5 in 54, L5/S1 in 10, L4/ S1 in 1 and L5,6 in 2. After decompression, Prospace was inserted into interbody space bilaterally, and located in disc space 4 mm beyond the rear edge of the vertebral body. Local laminectomy autograft was packed both laterally into and between 2 implants. Then the remanent local autograft was placed over facet bed. Pedicle screws were used after insertion of Prospace. Clinical results were evaluated by the JOA score. Disc height ratio and lumbar lordosis angles were measured on lateral radiographs. Fusion status was determined by evidence of bridge trabeculae across facet joint and interbody space on CT scan without mobility in lateral dynamic X-rays, and no radiolucent gap between Prospace and endplate. Paired t-test was used for statistical analysis. RESULTS: Mean blood loss and operative time was 384 ml and 178 minutes, respectively. The average JOA score at final follow-up (26.1 +/- 2.7) was significantly improved when compared with that of pre-operation (14.5 +/- 4.0, P < 0.05), with a mean recovery rate of JOA score 81.1% (37.5%-100.0%). The fusion rate was 97.4% (74/76). Mean disc height ratio and the involved segmental lordosis angle were increased from preoperative 0.27 +/- 0.07 and 5.8 +/- 2.2 degrees to 0.33 +/- 0.06 and 11.3 +/- 2.0 degrees respectively at the final follow-up, and the differences were significant (P < 0.05). There were no device-related complications. CONCLUSION: This surgical technique combined with Prospace interbody device is a safe and effective surgical option for patients with one-level lumbar disorders when PLIF is warranted.