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頁籤選單縮合
題名 | The Use of Interbody Cage Devices in the Lumbosacral Spine=腰薦椎椎間融骨器之使用 |
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作者 | 陳世豪; | 書刊名 | 臺灣外科醫學會雜誌 |
卷期 | 42:6 2009.11-12[民98.11-12] |
頁次 | 頁304-312 |
分類號 | 416.61 |
關鍵詞 | 椎間融骨器; 椎間盤; Interbody cage; Lumbosacral spine; Posterior instrumentation; |
語文 | 英文(English) |
中文摘要 | 使用椎間融骨器目的:恢復椎間盤高度,維持環帶纖維正常張力強度,使矢狀面平衡,減少小面關節鬆脫,加大神經孔洞空間,藉此維繫脊柱承受正常負重。目前沒有令人信服證據顯示:使用椎間融骨器矯正機械變形與減輕背痛症狀有成比例關係。原始椎間融骨器設計問題:圓柱體橫向寬度需大於椎間高度,撐開高度須不破壞小面關節。植入椎間籠要求終板的完整保護及滲血骨質暴露於移植骨料中。融骨器承受軸向壓縮力的中心部分須較外圍高30-50%以利融骨生長。未完全融骨穩定的椎節微動在所難免,釋出粒子會導致接觸面鬆脫;因此須後位椎弓根螺釘、經椎板小面關節螺釘合併使用來加強穩定。此類手術後遺症多與椎間籠體積較小、不對位擺置、小面關節全切除、缺乏後位固定及感染有關,會使椎間融骨器移位。外科醫生不能完全倚賴椎間融骨器的材質與生物力學特性來克服融骨失敗,有賴手術爭取最佳椎間融合條件。雖然生物材料合成椎間融合器的技術研究有希望,但最佳剛度和此類合成物被降解的時間要求仍然未知。 |
英文摘要 | Interbody devices are aimed to restore disc height, place annular fibers in a normal tension, create sagittal balance, reduce facet joints subluxation, enlarge neuroforaminal space, and maintain a normal weight-bearing proportion through the anterior column. There is no convincing evidence from controlled studies, however, to show that correcting the mechanical deformation is actually associated with symptomatic relief of back pain in patients who have such devices implanted. An inherent problem with cylindrical designs is that the lateral width of a paired cage construct is at least double the cage height, and the distractive height is limited without destruction of the facet joint. Cage bed preparation requires endplate integrity preserved and bleeding bone exposed to the graft material. The 30-50% higher compressive strength for central rather than for peripheral trabecular bone adapts to the shifts in axial load. Before solid arthrodesis, micromotion through the segment is unavoidable and particulate debris results in release of mediators and subsequent loosening of the device-bony interface. Pedicle screw, translaminar screw or transfacet screw fixation substantially improves stabilization. Adverse conditions, such as a small-sized cage, inadequate seating, total facetectomy, a lack of posterior instrumentation and infection, can cause migration of interbody devices. Surgeons cannot rely on the cage material/biomechanical properties to overcome failed arthrodesis, and must strive for the optimal milieu of fusion. Although early research into alternative biomaterials for cage technology is promising, the optimal cage stiffness and the desired period over which the cage will biodegrade remain unknown. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。