两种椎间融合法治疗退变性腰椎不稳症的疗效比较  

Comparative study of two different intervertebral body fusion in treating degenerative lumbar instability

作　　者：张建乔[1] 董黎强[2] 金才益[1] 曾忠友[1] 吴鹏[1] 王斌[1] 汤静彪[1] 

机构地区：[1]武警浙江总队医院骨二科,浙江省嘉兴市314000 [2]浙江中医药大学附属第二医院骨一科,杭州市311012

出　　处：《中国脊柱脊髓杂志》2008年第2期115-118,共4页Chinese Journal of Spine and Spinal Cord

摘　　要：目的:探讨椎弓根螺钉系统固定加碳纤维椎间融合器(cage)融合和椎弓根螺钉系统固定加椎间单纯植骨融合在治疗退变性腰椎不稳症中的临床疗效以及影像学结果。方法:2003年10月～2004年12月收治且获得2年以上随访的退变性腰椎不稳症患者共101例,均采用后路椎弓根螺钉系统固定,根据椎间融合方法不同,分为A组(cage椎间融合)和B组(椎间植骨融合)。A组男18例,女25例,平均年龄53.3岁;B组男33例,女25例,平均年龄56.2岁。按照0～9分法评估临床疗效,应用X线片评价两组患者植骨融合情况及椎间高度变化情况;比较两组患者的临床疗效和影像学结果等方面的差异。结果:A组优良率为93.0%,B组为77.6%。A组融合率为95.35%,B组为81.04%,两组间比较均有显著性差异(P<0.05)。术后7d,A组椎间高度平均为11.3±1.4mm,B组为11.2±1.6mm,两组比较无显著性差异(P>0.05),术后2年时A组为11.1±1.5mm,B组为9.2±1.4mm,两组椎间高度丢失率比较有显著性差异(P<0.05)。结论:在椎弓根螺钉系统固定的基础上,采用碳纤维椎间融合器融合治疗退变性腰椎不稳症在临床疗效、植骨融合率和维持椎间隙高度方面均优于椎间单纯植骨。Objective：To investigate the clinical and imaging outcome for the treatment of degenerative lumbar instability with posterior pedicle screw fixation plus carbon fiber cage interbody placement or bone graft interbody placement.Method：From October 2003 to December 2004,101 patients with degenerative lumbar instability treated with pedicle screw fixation and followed for more than two years were reviewed retrospectively.All patients were divided into group A（carbon fiber cage interbody placement） and B（bone graft interbody placement） based on interbody fusion method.In group A,there were 18 male and 25 female with an average age of 53.3 years（33 to 72 years）.In group B,there were 33 male and 25 female with an average age of 56.2 years（35 to 75 years）.The fusion status and interbody height between 2 groups were reviewed under radiographic documents.The clinical and imaging outcome of the two groups were compared.Result：93% cases of group A obtained excellent and good effect,while only 77.6% of group B did so.The fusion rate of group A was 95.35%,better than that of 81.04% in group B.At the 7th day after operation,the average intervertebral height of group A was 11.3±1.4mm,and those of group B was 11.2±1.6mm.2 years later,the average intervertebral height of group A was 11.1±1.5mm,while those of group B was 9.2±1.4mm.There was obvious difference between the two groups in clinical effect,intervertebral fusion rate and change of intervertebral height（P〈 0.05）.Conclusion：There is better therapeutic effect in degenerative lumbar instability treated with pedicle screw fixation plus carbon fiber cage interbody placement than with pedicle screw fixation plus bone graft interbody fusion.

关 键 词：腰椎退变性不稳症 碳纤维椎间融合器 椎间融合 

分 类 号：R681.5[医药卫生—骨科学]