中国组织工程研究

中国组织工程研究 ›› 2012, Vol. 16 ›› Issue (9): 1639-1642.doi: 10.3969/j.issn.1673-8225.2012.09.028

• 骨与关节生物力学 bone and joint biomechanics • 上一篇    下一篇

比较两种前段膨胀椎间融合器在椎间盘镜下治疗腰椎不稳症的生物力学特点☆

张春霖，杨通宝，朱红鹤，严  旭   

  1. 郑州大学第一附属医院骨科，河南省郑州市 450052
  • 收稿日期:2011-09-21 修回日期:2011-10-27 出版日期:2012-02-26 发布日期:2012-02-26
  • 作者简介:张春霖☆，男， 1965年生，河南省光山县人，汉族，1999年苏州大学医学院毕业，博士，教授，硕士生导师，主要从事脊柱微创外科、脊柱与关节手术机器人的研究。zzclin@126.com yangtongbao.007@163.com

Comparative study of biomechanical characteristics of two kinds of forepart-expansible cages for treating lumbar instability with microendoscopic discectomy

Zhang Chun-lin, Yang Tong-bao, Zhu Hong-he, Yan Xu   

  1. Department of Orthopedics, First Affiliated Hospital of Zhengzhou University, Zhengzhou  450052, Henan Province, China
  • Received:2011-09-21 Revised:2011-10-27 Online:2012-02-26 Published:2012-02-26
  • About author:Zhang Chun-lin☆, Doctor, Professor, Master’s supervisor, Department of Orthopedics, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, Chinazzclin@126.com, yangtongbao.007@163.com

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摘要：

背景：前段膨胀椎间融合器是近年来研制成功的一种新型膨胀式椎间融合器，有圆形与方形两种，其与椎体骨质的接触面积显著增大。
目的：比较圆形与方形两种前段膨胀椎间融合器在后路椎间盘镜下治疗腰椎失稳症的临床效果。
方法：在双牵开摆动椎间盘镜下应用前段膨胀椎间融合器治疗腰椎失稳症患者97例，其中圆形组51例，方形组46例，分别于单侧或双侧置入两枚圆形或方形前段膨胀椎间融合器。
结果与结论：按照功能障碍指数标准评估疗效，圆形组优 34例，良13例，可3例，差1例；方形组优33例，良10例，可2例，差1例，两组疗效比较差异无显著性意义。置入后6，12个月，圆形组椎间隙高度丢失率高于方形组(P < 0.05)。随访结束时圆形组与方形组分别有47，44例达骨性融合。圆形组3例发生翻转及向后方移位，方形组1例轻微硬脊膜撕破。提示方形前段膨胀椎间融合器较圆形者椎体沉降率低，与椎体的接触面积更大、更稳定，且采用“隔离置入技术”单侧置入双枚方形前段膨胀椎间融合器可显著降低置入难度。

关键词: 膨胀椎间融合器, 椎间盘镜, 腰椎不稳症, 对比研究, 隔离置入技术

Abstract:

BACKGROUND: The forepart-expansible cage is a kind of novel expansible cage developed in recent years, of which there are circular and square cages all with larger contact area.
OBJECTIVE: To compare the clinical effect of the two kinds of forepart-expansible cage in treatment of lumbar instability with microendoscopic discectomy (MED).
METHODS: Totally 97 cases with lumbar instability were underwent posterior lumbar interbody fusion (PLIF) using double tractors swing microendoscopic discectomy. Fifty-one patients were treated with the circular cages and forty-six with the square cases bilaterally or unilaterally.
RESULTS AND CONCLUSION: Evaluating clinical effect according to the Oswestry disability Index, the result for the circular group was excellent in 34 cases, good in 13 cases, fair in 3 cases and poor in 1 case. And for the square group, it was excellent in 33 cases, good in 10 cases, fair in 2 cases and poor in 1 case. There was no significant difference between the two kinds of forepart-expansible cages. The vertebral height loss rate of the circular group was higher than that of the square group at 6 and 12 months after procedure (P < 0.05). At the end of the follow-up, 47 cases of the circular group and 44 cases of the square group achieved bony healing. Complications such as one circular cage overturned and moved backward in 3 cases, and minor dural trauma occured in 1 case. The result indicates that the circular cage is much better with lower subsidence rate, larger contact area and more excellent stability. And two square cages can be placed conveniently unilaterally using the “isolation placing technique”.

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