Asazuma Takashi, Masuoka Kazunori, Motosuneya Takao, Tsuji Takashi, Yasuoka Hiroki, Fujikawa Kyosuke
Department of Orthopaedic Surgery, National Defense Medical College, Tokorozawa, Japan.
J Spinal Disord Tech. 2005 Feb;18 Suppl:S41-7. doi: 10.1097/01.bsd.0000112043.70321.1a.
Posterior lumbar interbody fusion (PLIF) is a standard surgical technique for the lumbar degenerative diseases. However, some problems such as collapse or retropulsion of the grafted bone and pseudoarthrosis have been reported when autogenous or cadaveric bone is used. Two iliac bone blocks with one-side cortex and one dense hydroxyapatite (HA) block were grafted together into the interbody space as in a sandwich. Cancellous bone chips locally harvested were also grafted onto the anterior and lateral aspect of the HA block. Twenty-six patients (12 males, 14 females) who could be followed minimally for 2 years were examined. The surgical outcome of each patient was evaluated by the Japanese Orthopaedic Association Assessment of Treatment of Low Back Pain (JOA score) and the recovery rate. Radiographic evaluation was based on the extent of bony union, the presence of a clear zone in the upper or lower margin of the HA block, cracking of the HA block, sinking of the HA block, and changes in lumbar-sagittal alignment pre- and postoperatively. The overall recovery rate ranged from 42.9% to 100% (mean 88.3%). Bony union was confirmed in 25 patients (96.2%). Clear zone was observed in 9 of 68 contact surfaces (13.2%). Sinking was observed in 8 of 34 segments (23.5%), and cracking of HA block was observed in 6 segments (17.6%). A mean loss of lordosis was found to be 2.4 degrees . The dense HA block is a useful substitute for autogenous bone graft for PLIF.
腰椎后路椎间融合术（PLIF）是治疗腰椎退行性疾病的一种标准外科技术。然而，据报道，当使用自体骨或尸体骨时，会出现一些问题，如移植骨塌陷或后凸以及假关节形成。将两块一侧带皮质骨的髂骨块和一块致密羟基磷灰石（HA）块像三明治一样一起植入椎间间隙。同时将局部采集的松质骨碎片也移植到HA块的前侧和外侧。对26例患者（12例男性，14例女性）进行了至少为期2年的随访检查。通过日本矫形外科学会下腰痛治疗评估（JOA评分）和恢复率对每位患者的手术结果进行评估。影像学评估基于骨融合程度、HA块上下边缘是否存在透亮区、HA块是否开裂、HA块是否下沉以及术前和术后腰椎矢状位排列的变化。总体恢复率在42.9%至100%之间（平均88.3%）。25例患者（96.2%）确认有骨融合。在68个接触表面中的9个（13.2%）观察到透亮区。在34个节段中的8个（23.5%）观察到下沉，在其中6个节段（17.6%）观察到HA块开裂。发现腰椎前凸平均丢失2.4度。致密HA块是PLIF中自体骨移植的一种有用替代物。
