中国组织工程研究

中国组织工程研究 ›› 2010, Vol. 14 ›› Issue (35): 6632-6635.doi: 10.3969/j.issn.1673-8225.2010.35.043

• 骨科植入物 orthopedic implant • 上一篇    下一篇

植入Cage及自体棘突、椎板颗粒骨填充行后路腰椎椎间融合治疗退变性腰椎疾病63例：远期随访

邢文华1，贾连顺1，霍洪军2，杨学军2   

  1. 1解放军第二军医大学上海长征医院骨科，上海市200003；2内蒙古医学院第二附属医院脊柱外科，内蒙古自治区呼和浩特市  010030
  • 出版日期:2010-08-27 发布日期:2010-08-27
  • 通讯作者: 贾连顺，主任医师，解放军第二军医大学上海长征医院骨科，上海市 200003 jialianshun@163.com
  • 作者简介:邢文华☆，1977年生，内蒙古自治区呼和浩特市人，汉族，解放军第二军医大学在读博士，主治医师，主要从事脊柱疾病的临床与基础研究。 xwhspine@sohu.com

Intervertebral bone fusion after posterior lumbar interbody fusion using the Cage impacted with laminar and processus spinosus bone chips in the treatment of degenerative diseases of the lumbar spine in 63 cases

Xing Wen-hua1, Jia Lian-shun1, Huo Hong-jun2, Yang Xue-jun2   

  1. 1 Department of Orthopedics, Changzheng Hospital, Second Military Medical University, Shanghai  200003, China; 2 Department of Spinal Surgery, Second Affiliated Hospital of Inner Mongolia Medical College, Hohhot  010030, Inner Mongolia Autonomous Region, China
  • Online:2010-08-27 Published:2010-08-27
  • Contact: Jia Lian-shun, Chief physician, Department of Orthopedics, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China jialianshun@163.com
  • About author:Xing Wen-hua☆, Studying for doctorate, Attending physician, Department of Orthopedics, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China xwhspine@sohu.com

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摘要：

背景：临床多见应用后路腰椎椎间融合+Cage行椎间融合时采用自体髂骨颗粒填充Cage治疗退变性腰椎疾病椎间融合率的报道，很少有整个融合过程中不同时间段的融合情况以及自体椎板颗粒骨椎间植骨融合率的远期随访报道。
目的：随访观察自体椎板、棘突作为骨源联合Cage植入行后路腰椎椎间融合的影像学随访结果及临床效果。
方法：选择退变性腰椎疾病患者63例，均为单一椎间隙病变，男24例，女39例；年龄46(35~72)岁，将全椎板减压后的自体椎板、棘突碎骨粒庆大霉素浸泡后充填于Cage内，应用髓核钳沿备好的Cage 通道将部分绞碎自体骨植入Cage 前间隙内，然后再沿备好的Cage通道植入Cage。随访53(37~62)个月；术后1周，3，6，12个月及远期行腰椎正侧位X射线片检查，观察患者不同时期椎间植骨融合情况。
结果与结论：63例患者中，51例患者成功融合(81%)，融合部位均位于Cage内及其前方，融合时间为术后6~12个月。所有患者腰腿痛症状消失或明显减轻，椎间融合好，椎间隙高度无明显减少。结果说明自体椎板、棘突作为骨源联合椎间Cage植入在后路腰椎椎间融合后可获得满意的融合结果。应用减压后的椎板骨颗粒填塞Cage及椎间植骨，可缩短手术时间，并减少取骨区的术后并发症。

关键词: 后路椎间植骨融合, 椎间融合器, 自体骨移植, 影像学, 医学植入物

Abstract:

BACKGROUND: There are many clinical reports about application of posterior lumbar interbody fusion (PLIF) with the Cage used autologous iliac bone particles in treatment of degenerative lumbar disease. But few studies reports state of fusion in different time and fusion rate of long-term follow-up using cages impacted with laminar and processus spinosus bone chips.
OBJECTIVE: To investigate the radiologic changes and clinical efficacy in the interbody bone fusion site in patients who had received PLIF using cages impacted with autoallergic laminar and processus spinosus bone chips.
METHODS: A total of 63 patients with degenerative lumbar disease were selected, including 24 males and 39 females, aged 46 years (rang 35-72 years). All cases were one level. The decompressed autologous vertebral plate and processus spinosus bone chips were soaked in gentamycin and filled in Cage. The autologous iliac bone particles were filled in the anterior diastema of Cage, and the Cage was implanted. The patients were followed up for 53 months (range 37–62 months). Anteroposterior and lateral radiograph films were taken from all patients after bone fusion at 1 week, 3, 6 and 12 months after surgery and at follow-up. The extent of the bone fusion was observed in different time.
RESULTS AND CONCLUSION: Of the 63 fusion levels, successful bone fusion was observed in 51 levels (81%). All the successful fusions occurred inside and anterior to the cages. Successful fusion time was 6 to 12 months after surgery. The pain in the lumbar spine and lower limb disappeared or alleviated obviously. Lumbar interbody fusion was good, and the height of lumbar intervertebral space was not lost significantly. PLIF using cages impacted with autoallergic laminar and processus spinosus bone chips is a useful method when considering the time required for surgery and the morbidity of the autograft donor sites.

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