经皮椎体间融合术治疗退行性下腰椎疾患的近期疗效观察.docVIP

经皮椎体间融合术治疗退行性下腰椎疾患的近期疗效观察 郭 江，陈向荣，徐国喜 （450025 郑州 解放军153医院脊柱外科） 【摘 要】 目的 观察可膨胀性椎间融合器B-twin 应用在经皮椎体间融合术治疗退行性下腰椎疾患中的近期疗效。方法 2006年1月至2009年3月,对41例共44间隙退行性下腰椎疾患患者在侧后路经皮穿刺B-twin 融合器植入椎间融合术。男性20例, 女性21例，年龄31～77岁, 平均57.51岁。退变性椎间盘膨出伴有椎体不稳和Ⅰ度滑脱25例，退变性椎间盘膨出伴有轻、中度椎间隙狭窄15例；椎间盘源性腰痛1例。手术融合节段：L3、L4、L5两间隙3例, L3、L4间隙3例, L4、L5间隙27例, L5、S1间隙8例。常规经皮椎间盘髓核摘除后, 处理椎体软骨终板，在“C”型臂X 线机透视下,选择合适尺寸的可膨胀性椎间融合器B-twin插入椎间隙内, 同时行椎间融合器外同种异体骨4～5g植骨融合。分别于术前，术后1周、3、12个月进行JOA评分评估临床治疗效果，同时进行X线片及CT检查观察融合器位置及融合情况。结果 随访时间3～38 个月( 平均16 个月) ,根据JOA评分标准评估临床治疗结果：优13例，良21例，可5例，差2例，优良率82.93%。3例B-twin 椎间融合器位置下沉, 其中1例明显下沉(大于20%)。融合器移位1例。 结论 经皮椎体间融合术在退变性下腰椎疾患治疗中具有创伤小，恢复快，近期临床效果可靠的优点,正确选择手术适应症和掌握手术的技术要点是确保疗效的前提。 【关键词】 经皮椎体间融合术；微创；脊柱融合术；B-twin 【中图法分类号】 【文献标志码】 A Percutaneous posterior interbody fusion with B-twin in the degenerative lumbar diseases: a short-term study on 41 cases Guo Jiang, Chen Xiangrong, Xu Guoxi (Department of Spinal Surgery, No. 153 Hospital of PLA, Zhengzhou, Hunan Province, 450025, China) 【Abstract】 Objective To explore the short-term clinical outcome of percutaneous posterior lumbar interbody fusion using B-Twin stand-alone expandable spinal spacer in the degenerative lumbar diseases. Methods From January 2006 to March 2009, 41 consecutive patients with lumbar degenerative disc diseases were enrolled and 44 intervertebral spaces were observed in this study. There were 20 males and 21 females, with an average age of 57.51 (ranging from 31 to 77 years old). Indications for treatment included degenerative lumbar disc herniation (LDH) with intervertebral instability or Ⅰo spondylolisthesis (25 cases), LDH with intervertebral space collapse (15 cases) and lumbar discogenic pain (1 case). Fusion segments included 3 cases of L3, L4 and L5, 3 cases of L3 and L4, 27 cases of L4 and L5, and 8 cases of L5 and S1. After percutaneous discectomy and endplate. curettage were meticulously carried out. A B-twin expandable spinal spacer was introduced into the interv