中国组织工程研究

中国组织工程研究 ›› 2021, Vol. 25 ›› Issue (21): 3332-3336.doi: 10.3969/j.issn.2095-4344.3868

• 脊柱植入物 spinal implant • 上一篇    下一篇

影响外侧入路腰椎椎间融合器置入后早期椎间隙高度的因素

赵洪顺，阿尖措，王德元，许志华，高顺红   

  1. 青海红十字医院骨科，青海省西宁市   810000
  • 收稿日期:2020-05-07 修回日期:2020-05-12 接受日期:2020-08-07 出版日期:2021-07-28 发布日期:2021-01-23
  • 通讯作者: 许志华，主治医师，青海红十字医院骨科，青海省西宁市 810000
  • 作者简介:赵洪顺，男，1985年生，青海省乐都县人，汉族，2010年内蒙古医科大学毕业，主治医师，主要从事于脊柱外科方面的研究。

Factors affecting the height of early intervertebral space after lumbar interbody fusion via lateral approach

Zhao Hongshun, A Jiancuo, Wang Deyuan, Xu Zhihua, Gao Shunhong   

  1. Department of Orthopedics, Qinghai Red Cross Hospital, Xining 810000, Qinghai Province, China
  • Received:2020-05-07 Revised:2020-05-12 Accepted:2020-08-07 Online:2021-07-28 Published:2021-01-23
  • Contact: Xu Zhihua, Attending physician, Department of Orthopedics, Qinghai Red Cross Hospital, Xining 810000, Qinghai Province, China
  • About author:Zhao Hongshun, Attending physician, Department of Orthopedics, Qinghai Red Cross Hospital, Xining 810000, Qinghai Province, China

PDF

58

摘要：

文题释义：
外侧入路腰椎椎间融合：是一种经外侧穿过腹膜后间隙和腰大肌的微创腰椎椎间融合技术，此项技术具有不需要经过腹腔、不需要分离大血管、神经丛以及后方肌肉结构的优点，同时更有利于椎间融合器的放置。
椎间隙高度：是由椎间盘撑起的纵向高度，其数值能够反映出椎间盘的状态和退变程度。同时整个脊柱的长度的25%是由椎间隙构成的，因而各类脊柱融合手术都力求恢复正常的椎间隙高度来恢复脊柱的形态和高度。

背景：术后椎间隙高度下降可能是机械负荷的自然结果，这种现象是万向螺钉头部的弯曲和融合器嵌入终板过程导致的。当这一现象与融合器沉降相结合时，椎间隙会明显变小，最终导致间接减压的效果丧失。
目的：分析影响外侧入路腰椎椎间融合后早期椎间隙高度降低的因素。
方法：选择2018年1至12月在青海红十字医院接受单节段或多节段外侧入路腰椎椎间融合合并后路内固定治疗的37例退行性腰椎病变患者，其中男22例，女15例，平均年龄(62.3±9.2)岁，总计72个融合节段。术前及术后即刻、术后1，3和6个月X射线侧位片被用于测量椎间隙前、后高度、平均椎间隙高度、腰椎间隙角和节段角。对椎间隙高度的降低和年龄、固定节段长度、术前腰椎弧度、术后腰椎弧度、椎间隙高度、融合器尺寸以及融合器位置等进行相关性分析。
结果与结论：①外侧入路放置的椎间融合器能够显著增加术后椎间隙前高度、椎间隙后高度、平均椎间隙高度和间隙角(P < 0.05)；②所有的术后椎间隙参数尤其是平均椎间隙高度的增加量与术后椎间隙高度的降低呈正相关关系(r=0.413，P < 0.05)；③椎间隙高度显著降低(≥25%)的节段在术后即刻的椎间隙高度增加明显，从(4.5±3.0) mm增加到(10.5±5.3) mm，增加了135.6%；然而术后椎间隙高度下降不显著(<25%)的节段术后即刻椎间隙高度相较于术前仅增加57.4%；④术后椎间隙高度增加越多，在早期随访中椎间隙高度损失越大；⑤因此，外侧入路腰椎椎间融合术中获取一个合理的椎间隙高度相较于过度矫正在手术策略的考量中更为重要。

https://orcid.org/0000-0003-1993-0614 (赵洪顺) 
中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

关键词: 腰椎, 退行性腰椎病变, 外侧入路, 椎间融合, 内固定, 椎间隙高度

Abstract: BACKGROUND: Mechanical loading could naturally cause postoperative disc height loss. Two main reasons causing this phenomenon were yielding of the polyaxial screw head and settling of the cage to the endplate. When cage subsidence appeared, significant reduction in the interbody space would emerge, which would compromise the indirect decompression.
OBJECTIVE: To analyze the factors affecting the disc height loss after lateral lumbar interbody fusion in the early follow-up.
METHODS: Totally 37 patients (22 males and 15 females with the mean age of 62.3±9.2 years) with degenerated lumber disease, who were treated with single or multi segmental lateral lumbar interbody fusion combined with posterior internal fixation in Qinghai Red Cross Hospital from January to December 2018, were included in this study. There were totally 72 fusion segments. Anterior disc height, posterior disc height, mean disc height, disc space angle, and segmental angle were measured on lateral plain X-ray images before, immediately, 1, 3, and 6 months after operation. The correlation of disc height loss with age, constructed segment length, preoperative lordosis, postoperative lordosis, disc height, cage parameters, and cage position was analyzed.
RESULTS AND CONCLUSION: (1) Cage placement in lateral lumbar interbody fusion significantly increased anterior disc height, posterior disc height, mean disc height, and disc space angle after surgery (P < 0.05). (2) There was a significant positive correlation between disc height parameters, especially the amount of mean disc height increase, and disc height loss after operation (r=0.413, P < 0.05). (3) Segments demonstrating significant height loss (≥25%) also achieved remarkable height increase immediately after operation, which increased by 135.6% from (4.5±3.0) mm to (10.5±5.3) mm. Otherwise, segments with height loss less than 25% had only 57.4% in postoperative height increase. (4) The greater the postoperative disc height increase, the greater the disc height loss across early follow-up. (5) Therefore, it is important to achieve a proper intervertebral space height rather than overcorrection when determining surgical strategy for lateral lumbar interbody fusion. 

Key words: lumbar vertebrae, degenerated lumber disease, lateral approach, intervertebral fusion, internal fixation, intervertebral space height

中图分类号: