赵志明;张永刚;王岩;肖嵩华;刘郑生;刘保卫;李海燕;

• 1:解放军总医院骨科医院

摘要(Abstract)：

[目的]评价腰椎后路椎体间融合(posterior lumbar interbody fusion,PLIF)术中应用双Cage和局部自体附件骨的融合率及术后5年的临床疗效。[方法]回顾接受PLIF手术、椎体间植入双Cage与局部附件骨、并行椎弓根钉内固定的84例患者的住院病历,并通过随访获得患者术前、术后1年、3年、5年的影像学资料,了解病人的康复情况,并用Oswestry功能障碍指数(Oswestry disability index,ODI)进行评分,观察椎体融合情况、相邻椎间隙退变情况(adjacent segment degeneration,ASD)。[结果]单间隙固定、二间隙固定、三间隙固定的患者术后1年、5年ODI评分比术前均有显著性降低(P<0.01);术后1年与术后5年ODI评分均无显著性差异(P>0.05)。术后1年融合率均为94.95%,术后3年融合率均为100%。术后5年部分患者遗留腰部发困、发僵、下坠感等腰痛不适症状,发生率22.61%(19/84),尚不能认为单间隙固定、二间隙固定、三间隙固定腰部不适发生率有差别。术后5年相邻椎间隙退变发生率19.04%(16/84)。具有相应症状、体征伴有ODI评分增加的ASD发生率2.38%(2/84)。[结论]PLIF应用双Cage结合自体局部附件骨植入、椎弓根内固定治疗下腰椎疾病椎体融合率高,术后1年、术后5年ODI评价临床疗效好。部分病人术后遗留有腰部不适。术后5年ASD多是影像学上的变化,极少产生临床症状。

关键词(KeyWords)： 腰椎后路椎体间融合;局部自体附件骨;临床疗效

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 赵志明;张永刚;王岩;肖嵩华;刘郑生;刘保卫;李海燕;

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参考文献(References)：

• [1]Thalgott JS,Fogarty ME,Giuffre JM,et al.A prospective,random-ized,blinded,single-site study to evaluate the clinical and radio-graphic differences between frozen and freeze-dried allograft when used as part of a circumferential anterior lumbar interbody fusion pro-cedure[J].Spine,2009,12:1251-1256.
• [2]Meisel HJ,Schnoring M,Hohaus C,et al.Posterior lumbar interbody fusion using rhBMP-2[J].Eur Spine J,2008,12:1735-1744.
• [3]Joseph V,Rampersaud YR.Heterotopic bone formation with the use of rhBMP2in posterior minimal access interbody fusion:a CTanalysis[J].Spine,2007,25:2885-2890.
• [4]Wong DA,Kumar A,Jatana S,et al.Neurologic impairment from ec-topic bone in the lumbar canal:a potential complication of off-label PLIF/TLIF use of bone morphogenetic protein-2(BMP-2)[J].Spine,2008,6:1011-1018.
• [5]Sasidhar V,Koichi S,Vijay K,et al.Biomechanical rationale for using polyetheretherketone(PEEK)spacers for lumbar interbody fusion-a finite element study[J].Spine,2006,26:992-998.
• [6]Fogel GR,Toohey JS,Neidre A,et al.Is one cage enough in posteriorlumbar interbody fusion:a comparison of unilateral single cage inter-body fusion to bilateral cages[J].J Spinal Disord Tech,2007,1:60-65.
• [7]Lee JH,Lee JH,Yoon KS,et al.Comparative study of unilateral and bilateral cages with respect to clinical outcomes and stability in instru-mented posterior lumbar interbody fusion[J].Neurosurgery,2008,1:109-113.
• [8]Dantas FL,Prandini MN,Ferreira MA.Comparison between posterior lumbar fusion with pedicle screws and posterior lumbar interbody fu-sion with pedicle screws in adult spondylolisthesis[J].Arq-Neurop-siquiatr,2007,3:764-770.
• [9]Min JH,Jang JS,Lee SH.Comparison of anterior-and posterior-ap-proach instrumented lumbar interbody fusion for spondylolisthesis[J].Neurosurg Spine,2007,1:21-26.
• [10]Jun HM,Jee SJ,Byung Joo J,et al.The clinical characteristics and risk factors for the adjacet segment degeneration in instrumented lum-bar fusion[J].Spinal Disord Tech,2008,5:306-309.
• [11]Wu CH,Wong CB,Chen LH,et al.Instrumented posterior lumbar in-terbody fusion for patients with degenerative lumbar scoliosis[J].J Spinal Disord Tech,2008,5:310-315.