腰椎后路单Cage单侧椎体间融合术在腰椎退变性疾病中的应用

中国临床解剖学杂志 ›› 2011, Vol. 29 ›› Issue (1): 100-104.

腰椎后路单Cage单侧椎体间融合术在腰椎退变性疾病中的应用

顾宇彤，　姚振均，　陈统一，　董　健，　姜晓幸，　张　键，　费琴明，　阎作勤

复旦大学附属中山医院骨科，上海 200032

收稿日期:2010-08-21 发布日期:2011-01-24
通讯作者: 姚振均，主任医师，硕士生导师，E-mail：yao-zhen-jun@　medmail.com.cn E-mail:tonygu633@hotmail.com
作者简介:顾宇彤（1970-），男，江苏南通人，博士，副主任医师，研究方向：骨科，脊柱外科

Posterior lumbar interbody fusion using a unilateral single cage in the degenerative lumbar spine

GU Yu-tong, YAO Zhen-jun, Chen Tong-yi, DONG Jian, JIANG Xiao-xing, ZHANG Jian, FEI Qin-ming, YAN Zuo-Qin

Department of Orthopaedics, Zhongshan Hospital of Fudan University, Shanghai, 200032,China

Received:2010-08-21 Published:2011-01-24

摘要/Abstract

摘要：

目的　对单Cage单侧PLIF治疗腰椎退变性疾病的临床疗效及放射影像学结果进行回顾性分析。方法　2005年10月至2008年3月间，使用填有移植骨的单Cage单侧PLIF技术为55例腰椎退变性疾病患者施行手术，术中将腰椎后路减压所取下的骨块咬碎后填于Cage前方，术后平均随访39.2个月。使用VAS法对患者的术前、术后1年及末次随访进行临床评估，用ODI法对术前及末次随访的功能进行评估，在末次随访中使用Prolo评分法，放射影像学可通过椎间高度、Cage周围的骨桥、射线透亮区及过伸过屈侧位片上椎间不稳的表现来评估。结果　VAS评分、ODI指数、Prolo评分均表明该术式的临床疗效非常令人满意，放射影像学评估显示术后6月时55例中有96.4%（53例）获牢固融合，末次随访时所有病例均获得完全融合。结论　单Cage单侧PLIF治疗腰椎退变性疾病，能维持合适的椎间高度，有可靠的脊柱稳定性、良好的骨连接和较高的骨融合率，可获得令人满意的临床疗效和放射影像学结果。

关键词: 脊柱融合术, 腰椎后路椎体间融合术, 单侧单CAGE椎间融合术, 局部自体骨植骨

Abstract:

Objective　We retrospectively evaluated the clinical and radiological outcomes of posterior lumbar interbody fusion (PLIF) using a unilateral single cage and a local morselized bone graft.　Methods　Fifty five patients who underwent PLIF with a unilateral single cage filled with local morselized bone graft were enrolled in this study. The average follow-up duration was 39.2 months. The clinical outcomes were evaluated with the visual analogue scale (VAS) at the pre-operative period, at 1 year post-operation and at the final follow-up, the Oswestry Disability Index and the Prolo scale at the final follow-up; the radiological outcomes were evaluated according to the change of bone bridging, the radiolucency, the instability and the disc height. Results　For the clinical evaluation, the VAS pain index, the Oswestry Disability Index and the Prolo scale showed excellent outcomes. For the radiological evaluation, 55 cases showed complete bone union at the final follow-up.　Conclusion　PLIF using a unilateral single cage filled with a local morselized bone graft for treating degenerative lumbar spine disease provides excellent outcomes according to the clinical and radiological evaluation.

Key words: Spinal fusion, Posterior lumbar interbody fusion, Unilateral single cage, Local morselized graft

中图分类号:

R681.5

顾宇彤, 姚振均, 陈统一,董健, 姜晓幸, 张键, 费琴明, 阎作勤. 腰椎后路单Cage单侧椎体间融合术在腰椎退变性疾病中的应用[J]. 中国临床解剖学杂志, 2011, 29(1): 100-104.

GU Yu-Tong, YAO Zhen-Jun, CHEN Tong-Yi, DONG Jian, JIANG Xiao-Xing, ZHANG Jian, FEI Qin-Ming, YAN Zuo-Qin. Posterior lumbar interbody fusion using a unilateral single cage in the degenerative lumbar spine[J]. Chinese Journal Of Clinical Anatomy, 2011, 29(1): 100-104.

参考文献

[1] Chiang MF, Zhong ZC, Chen CS, et al. Biomechanical comparison of instrumented posterior lumbar interbody fusion with one or two Cages by finite element analysis
[J]. Spine, 2006,31(19):E682-689.

[2] Videbaek TS, Christensen FB, Soegaard R, et al. Circumferential fusion improves outcome in comparison with instrumented posterolateral fusion: long-term results of a randomized clinical trial
[J]. Spine, 2006,31(25): 2875-2880.

[3] Cole CD, McCall TD, Schmidt MH, et al. Dailey Comparison of low back fusion techniques: transforaminal lumbar interbody fusion (TLIF) or posterior lumbar interbody fusion (PLIF) approaches
[J]. Curr Rev Musculoskelet Med, 2009,2:118–126.

[4] Diedrich O, Luring C, Pennekamp PH, et al. Effect of posterior lumbar interbody fusion on the lumbar sagittal spinal profile
[J]. Z Orthop Ihre Grenzgeb, 2003,141(4):425-432.

[5] Cloward RB. The treatment of ruptured lumbar intervertebral discs by vertebral body fusion: I. indications, operative technique, after care
[J]. J Neurosurg, 1953,10(2):154-168.

[6] Carmouche JJ, Molinari RW. Epidural abscess and discitis complicating instrumented posterior lumbar interbody fusion: a case report
[J]. Spine, 2004,29(23): E542-546.

[7] Chen L, Tang T, Yang H. Complications associated with posterior lumbar interbody fusion using Bagby and Kuslich method for treatment of spondylolisthesis
[J]. Chin Med J (Engl), 2003,116(1):99-103.

[8] Fogel GR, Toohey JS, Neidre A, Brantigan JW. Outcomes of L1-L2 posterior lumbar interbody fusion with the Lumbar I/F cage and the variable screw placement system: re porting unexpected poor fusion results at L1-L2
[J]. Spine J, 2006,6(4):421-427.

[9] Miura Y, Imagama S, Yoda M, et al. Is local bone viable as a source of bone graft in posterior lumbar interbody fusion
[J]? Spine, 2003,28(20):2386-2389.

[10]Trèves R, Scotto C, Bertin P, et al. Do visual analog scale pain scores change during a rheumatologist visit
[J]. Joint Bone Spine, 2002,69(2):234-235.

[11]Fairbank JC, Pynsent PS. The Oswestry disability index
[J]. Spine, 2000,25 (21):2940-2953.

[12]郑广新, 赵晓欧, 刘广林, 等. Oswestry功能障碍指数评定腰痛患者的可信性
[J]. 中国脊柱脊髓杂志, 2002,12(1):13-15.

[13]Prolo DJ, Oklund SA, Butcher M. Toward uniformity in evaluating results of lumbar spine operations: a paradigm applied to posterior lumbar interbody fusions
[J]. Spine, 1986,11(6):601-606.

[14]Davis RA. A long-term outcome analysis of 984 surgically treated herniated lumbar discs
[J]. J Neurosurg, 1994,80(3):415-421.

[15]Choy WS, Kim WJ, Kim KH, et al. Th e results of the posterior lumbar interbody fusion using titanium mesh cage for spondylolisthesis
[J]. J Korean Soc Spine Surg, 1999,6(1):129-134.

[16]Chen L, Yang H, Tang T. Cage migration in spondylolisthesis treated with posterior lumbar interbody fusion using BAK cages
[J]. Spine, 2005,30(19):2171-2175.

[17]Zhao J, Hai Y, Ordway NR, et al. Posterior lumbar interbody fusion using posterolateral placement of a single cylindrical threaded cage
[J]. Spine, 2000,25(4):425-430.

[18]Fogel GR, Toohey JS, Neidre A, et al. Is one cage enough in posterior lumbar interbody fusion: a comparison of unilateral single cage interbody fusion to bilateral cages
[J]. J Spinal Disord Tech, 2007,20(1):60-65.

[19]Oxland TR, Lund T. Biomechanics of stand-alone cages and cages in combination with posterior fixation: a literature review
[J]. Eur Spine J, 2000,9(Suppl 1):S95-101.

[20]Kim DH, Jeong ST, Lee SS. Posterior lumbar interbody fusion using a unilateral single cage and a local morselized bone graft in the degenerative lumbar spine
[J]. Clin Orthop Surg, 2009,1(4):214-221.