Diedrich O, Lüring C, Pennekamp P H, Perlick L, Wallny T, Kraft C N
Klinik und Poliklinik für Orthopädie der Rheinischen Friedrich-Wilhelms Universität zu Bonn, Germany.
Z Orthop Ihre Grenzgeb. 2003 Jul-Aug;141(4):425-32. doi: 10.1055/s-2003-41561.
To determine the effect of different cage geometries and posterior instrumentation on the sagittal spinal profile after monosegmental lumbar interbody fusion.
The study is based on a retrospective analysis of 119 patients with segmental instability, who were surgically managed by monosegmental PLIF with PEEK-Cages and dorsal instrumentation.
At radiographic follow-up after surgery we found a significant improvement of the lumbar sagittal spinal profile, independent of the cage geometry utilised. A marked discrepancy between 0 degrees -standard and 4 degrees -trapezoid implants concerning the radiographic parameters lumbar lordosis, disc height, correction of spondylolisthesis and sacral inclination was not found. With the use of 4 degrees optimised cages in segment L4/5 slightly better results for segmental lordosis were obtained. Reliability of the radiographic evaluation, expressed as intra-observer error, was satisfactory. Cage geometry did not have an effect on the clinical result. By combining interbody fusion with pedicular instrumentation the reposition of slipped vertebra and distraction of the interbody space could more effectively be achieved. Patients without dorsal instrumentation had a higher rate of pseudarthrosis as well as a less satisfactory clinical outcome.
These results show that normal sagittal alignment after single-level lumbar fusion can be achieved with rectangular and 4 degrees -wedged cages. Although results after utilization of 4 degrees -wedged cages do not significantly differ, these implants offer the surgeon one more sizing variation with which physiological lumbar lordosis may be attained. The combination of intersomatic implants with dorsal instrumentation achieves a more precise realignment and has a lower rate of cage-associated complications. It therefore seems prudent that an interbody fusion for the surgical management of lumbar segmental instability should be combined with pedicular instrumentation.
确定单节段腰椎椎间融合术后不同椎间融合器几何形状及后路内固定对脊柱矢状面形态的影响。
本研究基于对119例节段性不稳患者的回顾性分析，这些患者接受了单节段后路腰椎椎间融合术（PLIF），使用聚醚醚酮（PEEK）椎间融合器及后路内固定。
术后影像学随访发现，无论使用何种椎间融合器几何形状，腰椎矢状面形态均有显著改善。未发现0度标准型与4度梯形椎间融合器在腰椎前凸、椎间盘高度、椎体滑脱矫正及骶骨倾斜度等影像学参数上存在明显差异。在L4/5节段使用4度优化椎间融合器时，节段性前凸的效果稍好。以观察者内误差表示的影像学评估可靠性令人满意。椎间融合器几何形状对临床结果无影响。通过椎间融合与椎弓根内固定相结合，可更有效地实现滑脱椎体的复位及椎间间隙的撑开。未行后路内固定的患者假关节形成率较高，临床结果也较差。
这些结果表明，使用矩形和4度楔形椎间融合器均可实现单节段腰椎融合术后正常的矢状面排列。尽管使用4度楔形椎间融合器后的结果无显著差异，但这些植入物为外科医生提供了更多尺寸选择，有助于获得生理性腰椎前凸。椎间融合器与后路内固定相结合可实现更精确的复位，且与椎间融合器相关的并发症发生率较低。因此，对于腰椎节段性不稳的手术治疗，椎间融合术与椎弓根内固定相结合似乎更为稳妥。
