中华放射学杂志
中華放射學雜誌
중화방사학잡지
Chinese Journal of Radiology
2009年
10期
1087-1091
,共5页
郭江%焦文仓%陈向荣%李晓予
郭江%焦文倉%陳嚮榮%李曉予
곽강%초문창%진향영%리효여
脊椎前移%脊柱融合术%腰椎%放射学,介入性
脊椎前移%脊柱融閤術%腰椎%放射學,介入性
척추전이%척주융합술%요추%방사학,개입성
Spondylolisthesis%Spinal fusion%Lumbar vertebrae%Radiology,interventional
目的 探讨经皮穿刺腰椎椎间固定融合术的可行性、技术要点、手术适应证和临床效果.方法 回顾性分析32例经皮穿刺腰椎椎间固定融合术患者的临床资料.32例患者中男、女各16例,年龄31～77岁;病程平均(5.0±2.0)年,手术采用经皮穿刺腰椎间盘髓核摘除术对椎间盘减压后,用括匙将上下软骨终板破坏,将1枚可膨胀的椎间融合器B-Twin斜向置入椎间隙内形成固定的支架,然后在周围植骨,以保证椎体间的稳定效果.治疗的适应证:(1)退变性椎间盘膨出伴有椎体不稳和Ⅰ度滑脱21例;(2)退变性椎间盘膨出伴有轻、中度椎间隙狭窄10例;(3)盘源性腰痛1例.疗效评定标准采用日本矫形外科协会(JOA)下腰痛评分标准,在术前、术后3个月和1年3个时间对患者的症状和功能分别进行评分,计算术后改善率和疗效.对患者手术前后的JOA评分的变化进行方差分析,术后2次随访的改善率比较采用χ~2检验.结果 本组患者手术过程顺利,每个椎间隙手术时间50～90 min(平均60 min),出血量<20 ml.手术部位:L3～4间隙4例、L4～5间隙19例、L5～S1间隙6例、L3～4合并L4～5间隙3例,共置入B-Twin融合器35枚,其中3例在2个椎间隙内置入.患者平均住院时间(10.0±2.1)d,2例出现手术并发症,1例融合器松动,1例出现相邻椎间不稳.术后随访时间3～36个月,平均13个月.32例患者JOA下腰痛评分,术前为(4.1±1.8)分、术后3个月为(11.9±3.9)分,术后1年随访22例,JOA评分(12.0±3.2)分,手术前后JOA下腰痛评分差异有统计学意义(F=5.67,P<0.01);改善率,术后3个月为(61.7±23.6)%,术后1年为(58.2±21.0)%,两者差异无统计学意义(F=4.18,P>0.05).结论 经皮穿刺腰椎椎间固定融合术治疗退变性椎间盘突出症和椎体不稳具有损伤小、不破坏脊柱稳定结构的特点,但对椎间融合率以及远期效果还需进一步观察和深入研究.
目的 探討經皮穿刺腰椎椎間固定融閤術的可行性、技術要點、手術適應證和臨床效果.方法 迴顧性分析32例經皮穿刺腰椎椎間固定融閤術患者的臨床資料.32例患者中男、女各16例,年齡31～77歲;病程平均(5.0±2.0)年,手術採用經皮穿刺腰椎間盤髓覈摘除術對椎間盤減壓後,用括匙將上下軟骨終闆破壞,將1枚可膨脹的椎間融閤器B-Twin斜嚮置入椎間隙內形成固定的支架,然後在週圍植骨,以保證椎體間的穩定效果.治療的適應證:(1)退變性椎間盤膨齣伴有椎體不穩和Ⅰ度滑脫21例;(2)退變性椎間盤膨齣伴有輕、中度椎間隙狹窄10例;(3)盤源性腰痛1例.療效評定標準採用日本矯形外科協會(JOA)下腰痛評分標準,在術前、術後3箇月和1年3箇時間對患者的癥狀和功能分彆進行評分,計算術後改善率和療效.對患者手術前後的JOA評分的變化進行方差分析,術後2次隨訪的改善率比較採用χ~2檢驗.結果 本組患者手術過程順利,每箇椎間隙手術時間50～90 min(平均60 min),齣血量<20 ml.手術部位:L3～4間隙4例、L4～5間隙19例、L5～S1間隙6例、L3～4閤併L4～5間隙3例,共置入B-Twin融閤器35枚,其中3例在2箇椎間隙內置入.患者平均住院時間(10.0±2.1)d,2例齣現手術併髮癥,1例融閤器鬆動,1例齣現相鄰椎間不穩.術後隨訪時間3～36箇月,平均13箇月.32例患者JOA下腰痛評分,術前為(4.1±1.8)分、術後3箇月為(11.9±3.9)分,術後1年隨訪22例,JOA評分(12.0±3.2)分,手術前後JOA下腰痛評分差異有統計學意義(F=5.67,P<0.01);改善率,術後3箇月為(61.7±23.6)%,術後1年為(58.2±21.0)%,兩者差異無統計學意義(F=4.18,P>0.05).結論 經皮穿刺腰椎椎間固定融閤術治療退變性椎間盤突齣癥和椎體不穩具有損傷小、不破壞脊柱穩定結構的特點,但對椎間融閤率以及遠期效果還需進一步觀察和深入研究.
목적 탐토경피천자요추추간고정융합술적가행성、기술요점、수술괄응증화림상효과.방법 회고성분석32례경피천자요추추간고정융합술환자적림상자료.32례환자중남、녀각16례,년령31～77세;병정평균(5.0±2.0)년,수술채용경피천자요추간반수핵적제술대추간반감압후,용괄시장상하연골종판파배,장1매가팽창적추간융합기B-Twin사향치입추간극내형성고정적지가,연후재주위식골,이보증추체간적은정효과.치료적괄응증:(1)퇴변성추간반팽출반유추체불은화Ⅰ도활탈21례;(2)퇴변성추간반팽출반유경、중도추간극협착10례;(3)반원성요통1례.료효평정표준채용일본교형외과협회(JOA)하요통평분표준,재술전、술후3개월화1년3개시간대환자적증상화공능분별진행평분,계산술후개선솔화료효.대환자수술전후적JOA평분적변화진행방차분석,술후2차수방적개선솔비교채용χ~2검험.결과 본조환자수술과정순리,매개추간극수술시간50～90 min(평균60 min),출혈량<20 ml.수술부위:L3～4간극4례、L4～5간극19례、L5～S1간극6례、L3～4합병L4～5간극3례,공치입B-Twin융합기35매,기중3례재2개추간극내치입.환자평균주원시간(10.0±2.1)d,2례출현수술병발증,1례융합기송동,1례출현상린추간불은.술후수방시간3～36개월,평균13개월.32례환자JOA하요통평분,술전위(4.1±1.8)분、술후3개월위(11.9±3.9)분,술후1년수방22례,JOA평분(12.0±3.2)분,수술전후JOA하요통평분차이유통계학의의(F=5.67,P<0.01);개선솔,술후3개월위(61.7±23.6)%,술후1년위(58.2±21.0)%,량자차이무통계학의의(F=4.18,P>0.05).결론 경피천자요추추간고정융합술치료퇴변성추간반돌출증화추체불은구유손상소、불파배척주은정결구적특점,단대추간융합솔이급원기효과환수진일보관찰화심입연구.
Objective To characterize the feasibility, key technology, indications and clinical outcome of percutaneous lumbar interbody fusion. Methods Clinical data from 32 cases [16 made, 16 female, age range 31-77 years, average disease duration (5.0±2.0) years ] underwent percutaneous nucleotomy and endplate curettage was retrospectively analyzed. After percutaneous nucleotomy and endplate curettage, one expandable spinal spacer B-twin was introduced into the intervertebral space and some allograft cancellous bone implanted around the B-twin. Indications for treatment included degenerative lumbar disc herniation (LDH) with intervetebral distability or Ⅰ degree spondylolythesis (21 cases), LDH with intervetebral space collapse (10 cases) and lumbar discogenic pain (1 case). The symptoms and function of all patients were evaluated before, 3 months and 12 months after the operation by clinical outcome judgment criterion of surgical treatment for low back pain formulated by JOA, and the rate of clinical improvement and treatment efficacy were calculated. The JOA scales preoperatively, postoperatively and on the final follow-up was compared using ANOVA in SPSS. The changes before and after surgery with the JOA score and the the rate of clinical improvement between 3 months and 12 months after the operation was also compared using χ~2 test. Results The average operation time 1 hour and blood loss < 20 ml, Surgical site: L3-4 4 cases, L4-5 19 cases, I5-S1 6 cases, L3-4 and L4-5 3 cases, B-TWIn were implanted fusion cage 35, in three cases of intervertebral space with two implantso Average in Hospital time was (10.0±2.1) d . Complication included 1 case with displacement and 1 case with secondary instability of next intervertebral space. All the patients were evaluated after a follow-up of 3-36 months (average 13 months) 32 cases of patients with low back pain JOA score: before surgery is(4.1±1.8), 3 months after surgery is (11.9±3.9), 1 year after surgery of the 22 cases is (12.0±3.2). Score before and after surgery were statistically significant differences (F = 5.67, P < 0.01). The rate of clinical improvement After surgery there was no significant difference (F = 4.18, P > 0.05). Conclusions Percutaneous posterior lumbar interbody fusion with B-twin expandable fusion cage could lead to satisfactory outcome in the treatment of degenerative disc disease and intervertebral instability,which minimize surgical soft tissue and trauma spinal damage, does not destroy the structure of spinal stability. The technique The long-term outcome, complications and fusion rate need further observing.
