膨胀性椎间融合器在腰椎融合术中的应用研究

Early follow-up of lumbar fusion with expandable intervertebral cage

摘要:

目的  探讨膨胀性椎间融合器在腰椎融合术中的应用价值。方法  选取2010年6月-2014年6月采用膨胀性椎间融合器行腰椎融合术69例（治疗组），与同期行腰椎椎弓根内固定的椎间融合术72例患者（对照组）进行比较。采用日本矫形外科协会（JOA）下腰痛评分标准评定临床疗效；采用视觉模拟评分法（VAS）评价患肢疼痛的改善情况；采用腰椎前凸角评价腰椎曲度；椎间植骨融合通过术后腰椎X线片、动力位X线片及薄层三维CT重建检查按照Suk标准判定，同时观察过伸过屈位时植入物的稳定性。结果  全部患者随访时间>18个月。两组手术时间、切口长度、出血量、引流量、住院时间比较，差异有统计学意义（P <0.05），治疗组低于对照组。并发症方面，治疗组3例患者出现脑脊液漏，对照组2例患者出现脑脊液漏，两组均无感染、神经根损伤及内植物松动、移位等并发症。末次随访时两组椎间植骨均获得融合或可能融合，治疗组JOA评分由术前的（4.52±1.78）分提高到（12.57±2.96）分、改善率为（76.81±7.20）%，VAS评分由术前的（4.45±1.58）分降至（1.92±0.62）分，腰椎前凸角由（28.50±16.30）°变为（30.20±12.50）°；B组JOA评分由术前的（4.71±1.26）分提高到（12.31±2.85）分、改善率为（73.86±8.60）%，VAS评分由术前的（4.68±1.51）分降至（2.13±1.93）分，腰椎前凸角由术前的（27.50±15.20）°变为（23.90±13.20）°。两组同期JOA评分、改善率及VAS评分比较，差异无统计学意义（P >0.05）；两组腰椎前凸角比较，差异有统计学意义（P <0.05），治疗组较对照组能够更好地维持腰椎前曲。结论  应用膨胀性融合器行腰椎融合术，可以取得满意的椎间融合效果，同时具有创伤小、住院时间短、能够维持腰椎前曲的优点。

Abstract:

Objective To observe the early clinical results and complications of lumbar interbody fusion with expandable intervertebral cage. Methods Between June 2010 and June 2014, 69 patients were treated with the expansion of the fusion cage for lumbar interbody fusion (treatment group), 72 patients were treated with pedicle screw fixation for lumbar interbody fusion (control group), and the two groups were compared. The clinical curative effect was evaluated by the Japanese Orthopedic Association (JOA) lumbago scoring. Visual Analog Scale (VAS) was used to evaluate low back pain. Lumbar lordosis was used for evaluation of lumbar curvature. Through postoperative lumbar X-ray, dynamic X-ray film and CT, intervertebral bone graft fusion was evaluated. According to the standard of Suk judgment, the cage stability was observed at hyperextension and flexion positions. All the data were statistically analyzed. Results All the cases were followed up for more than 18 months. There were significant differences in the operation time, incision length, bleeding volume, drainage volume and hospitalization time between the two groups (P < 0.05). Cerebrospinal fluid leakage appeared in 3 cases of the treatment group and 2 cases of the control group. There was no infection, nerve function injury, internal plant loosening or displacement, or other complications in either group. At the end of the follow-up, both groups obtained fusion of intervertebral bone graft. In the treatment group, JOA scores increased from preoperative (4.52 ± 1.78) points to postoperative (12.57 ± 2.96) points, the improvement rate was (76.81 ± 7.20)%; VAS score was reduced from preoperative (4.45 ± 1.58) points to postoperative (1.92 ± 0.62) points; the lumbar lordosis angle enlarged from (28.50 ± 16.30)° preoperatively to (30.20 ± 12.50)°. In the control group, JOA scores increased from preoperative (4.71 ± 1.26) points to postoperative (12.31 ± 2.85) points, the improvement rate was (73.86 ± 8.60)%; VAS score was reduced from preoperative (4.68 ± 1.51) points to postoperative (2.13 ± 1.93) points; the lumbar lordosis angle reduced from (27.50 ± 15.20)° preoperatively to (23.90 ± 13.20)°. There was no significant difference in JOA score, improvement rate or VAS score between both groups (P > 0.05). Lumbar lordosis angle of the two groups had significant difference (P < 0.05), the treatment group could maintain the anterior lumbar flexure better than the control group. Conclusions Lumbar fusion with expandable intervertebral cage can provide satisfied effect of intervertebral fusion. It has the advantages of little trauma and short hospital stay, and can maintain lumbar lordosis angle.