摘要
目的：总结腰椎失稳症患者病变椎间隙 X 线解剖学特征,并提出分型,以期为临床应用椎间融合器提供指导。方法回顾性分析2013年1月—2015年1月在郑州大学第一附属医院骨科采用后路镜（双牵开摆动式椎间盘镜）微创融合术及联合经皮椎弓根钉内固定术治疗130例腰椎失稳症患者的资料,其中男69例,女61例；年龄15~76岁,平均49岁。130例患者共有209个病变节段：L1/28个,L2/39个,L3/434个,L4/590个,L5/ S168个。在腰椎侧位 X 线影像上测量腰椎间隙前缘高度（a）、椎间隙盘状小凹前端高度（b）、椎间隙后缘高度（c）等数据,依据 a/ b、c/ b 比值将腰椎间隙分为6型：AD 型（a/ b 〉1且 c/ b 〉0.5）,AE 型（a/ b 〉1且 c/ b≤0.5）、BD 型（a/ b =1且 c/ b 〉0.5）、BE 型（a/ b =1且 c/ b≤0.5）、CD 型（a/ b 〈1且 c/ b 〉0.5）、CE 型（a/ b 〈1且 c/ b≤0.5）。术后 X 线检查评估端膨胀融合器位置变化,CT 检查评估融合情况。采用日本骨科学会（JOA）评分评价手术疗效。结果对209个腰椎间隙均行后路镜下置入端膨胀融合器,其中9例合并Ⅰ度（7例）或Ⅱ度（2例）腰椎滑脱者联合经皮椎弓根钉内固定术。所有腰椎间隙中 AD 型占78.0%（163/209）,AE 型占10.5%（22/209）, BD 型占8.6%（18/209）, BE 型占2.4%（5/209）,CD 型占0.5%（1/209）, CE型未见。术后随访3~24个月。按 JOA 评分,改善率为86.4%。按疗效分级标准：治愈91例,显效31例,有效8例。按 Suk 标准,86个椎间隙（41.1%,86/209）达到坚固融合,123个椎间隙（58.9%,123/209）达到可能融合。1例 AD 型椎间隙端膨胀融合器2枚下沉、1例 BD 型椎间隙端膨胀融合器1枚下沉,总下沉率为0.7%（3/418）,1例 CD 型椎间隙端膨胀融合器后移,总移位率为0.2%（1/418）。本组无一例发生神经损伤或死亡。结论对腰椎失稳症患者腰椎间隙进行 X 线解剖学分型可为后路镜下微创椎间融合术端膨胀融合器的植入位置确定及移位趋势评估提供指导,能减少或避免融合器移位等并发症的发生,提高治疗效果。
Objective To sum up the anatomic features of lumbar intervertebral space and classify of X-ray images, to provide the guidance for the clinical application of theforepart-expansible cage. Methods One hundred and thirty cases of lumbar instability treated with micro-endoscopic discectomy （ MED） and posterior lumbar interbody fusion using the forepart-expansible cage and combined with percutaneous pedicle screw internal fixation from January 2013 to January 2015 in the First Affiliated Hospital of Zhengzhou University were retrospective analyzed. There were 69 males and 61 females, with an average age of 49 years （15 - 76 years）. There were 209 segmental lesions： L1 / 2 8 lesions, L2 / 3 9 lesions, L3 / 4 34 lesions, L4 / 5 90 lesions, and L5 / S1 68 lesions. The following indicators of each segmental lesion were measured in lumbar lateral X-ray images： the anterior intervertebral heights （a）, anterior Disc Pit heights （b）, and posterior intervertebral heights （c）. According to the ratio of a/ b and c/ b, the intervertebral space can be classified into six types： AD（a/ b 〉 1 and c/ b 〉 0. 5）, AE （a/ b 〉 1 and c/ b≤0. 5）, BD （a/ b = 1 and c/ b 〉 0. 5）, BE （a/ b = 1 and c/ b ≤0. 5）, CD （ a/ b 〈 1 and c/ b 〉 0. 5）, and CE （ a/ b 〈 1 and c/ b ≤0. 5）. Postoperative X-ray was performed to confirm cage position change, postoperative CT was performed to confirm fusion. According to the Japan Department of Orthopedics （ JOA ） , the effect of surgery was evaluated. Results There were 209 segmental lesions in 130 cases of lumbar instability. All the patients treated with MED and posterior lumbar interbody fusion using the forepart-expansible cage,there were 9 cases＆nbsp;with gradeⅠ （7 cases） and grade Ⅱ（2 cases） lumbarspondylolisthesis combined with percutaneous pedicle screw internal fixation. The ratio of AD, AE, BD, BE, CD accounted for 78. 0% （163 / 209）, 10. 5% （163 /209）, 8. 6% （22 / 209）, 2. 4% （18 / 209）, 0. 5% （51 / 209）. The patients were followed-up for 3 - 24 months. According to the JOA, improvement rate was 86. 4% . According to the classification standard, 91 patients were cured, 31 patients had marked effect, 8 patients were effective. According to Suk criterion, solid union occurred in 86 cases （41. 1% , 86 / 209） and probable union in 123 cases （58. 9% , 123 / 209）. Subsidence of two cages was found in one case of AD type, and one cage was found in one case of BD type. The total subsidence rate was 0. 7% （3 / 418）. Displacement of one cage was found in one case of CD type. The total displacement rate was 0. 2% （1 / 418）. None nerve injury or death case was found. Conclusions X-ray anatomic classification of lumbar intervertebral space can provide the guidance for choosing the placement and estimating the displacement trend of the forepart-expansible cage with micro endoscopic discectomy and posterior lumbar interbody fusion, reduce or avoid the cage move, and improve effect of surgical treatment.
出处
《中华解剖与临床杂志》
2015年第6期488-493,共6页
Chinese Journal of Anatomy and Clinics
关键词
腰椎
椎间隙
X
线
解剖学
端膨胀融合器
Lumbar vertebra
Vertebral space
X-ray
Anatomy
Forepart-expansible cage
