微创B-Twin椎间融合器治疗腰椎不稳疗效分析.docVIP

微创B-Twin椎间融合器治疗腰椎不稳疗效分析 　 作者：杨进顺，廖壮文，黄文铎 【摘要】 [目的]探讨后路小切口B-Twin椎间融合术治疗退行性腰椎不稳症的手术特点和临床疗效。[方法]收治退行性腰椎不稳症患者13例13间隙，其中L4、5节段不稳11例，L5S1节段不稳2例。患者均行后路小切口开放手术B-Twin椎间融合术，疗效评价采用日本矫形外科协会(JOA)下腰痛评分标准。[结果]所有患者术后均无感染、神经功能损伤及融合器脱落等并发症。随访时间 12～23个月(平均16.2 个月)，13例患者术前JOA 评分平均4.2分, 随访结束时JOA 评分平均14.4分，JOA评分术后改善率：优11例, 良1例, 可1例, 差0 例, 优良率92.3%。13例患者椎间植骨均获得融合，平均植骨融合时间为19.8 周。随访过程B-twin椎间融合器位置良好，椎间隙高度除有2例丢失外(lt;10%)，其余的无明显改变。[结论]对于合并有轻度退行性腰椎不稳的腰椎间盘源性疾病患者使用后路小切口B-Twin可膨胀性椎间融合器联合大量自体颗粒骨植骨融合手术治疗具有创伤小、安全性高、植骨融合率高，且临床疗效可靠的优点，值得进一步探讨。 【关键词】 退行性腰椎不稳; 椎间融合; B-Twin 　　Abstract: [Objective]To explore the effect of B-Twin intervertebral cage for degenerative lumbar instability with posterior mini-incision. [Methods]Thirteen patients (13 disc-spaces) treated with B-Twin intervertebral cage in combination with autogenous morselized bone were enrolled in this study. Among the patients, 11 had degenerative instability in L4、5 and 2 in L5S1. Patients were graded postoperatively with JOA scoring system.[Results]The lower back pain and leg pain were relieved significantly in all patients after operation. All were followed-up for an average of 16.2 months, and the JOA scores inproved from 4.2 preoperatively to 14.4 at the final follow-up. The good to excelleat rate was 92.3%. The bony fusions presented in an average of 19.8 weeks postoperatively by CT scan. Neither cage loosening nor neurological injury was found.[Conclusion]B-Twin intervertebral cage combined with autogenous morselized bone insertion for lumbar degenerative instability by posterior mini-incision operation is a good technique , which could achieve satisfactory clinical results with less injury. 　　Key words：degenerative lumbar instability; interbody fusion; B-Twin 　　退行性腰椎间盘源性疾病是骨科常见病，经非手术治疗无效者须手术治疗。然而，单纯后路椎间盘髓核摘除术术后常出现脊柱不稳加重，腰腿痛症状再发等情况。腰椎后路椎体间植骨融合术(posterior lumbar interbody fusion，PLIF)是目前解决那些有脊柱不稳或潜在不稳的患者理想方法，由于传统的后路椎间融合、椎弓根钉内固定手术有创伤大、技术要求高等缺点，微创椎间融合术已成为目前探讨的热点。本科从2006年6月～2007年6月，针对合并有轻度退行性腰椎不稳的腰椎间盘源性疾病患者采取后路小切口微创手术行椎间盘摘除，椎管减压，自体颗粒骨植骨联合