两种后路脊柱融合方法治疗腰椎不稳的比较  

Comparison of two kinds of posterior spinal fusion for lumbar instability

作　　者：肖志勤[1] 

机构地区：[1]湖南省安化县人民医院骨科,湖南安化413500

出　　处：《中国现代医学杂志》2010年第8期1269-1272,1275,共5页China Journal of Modern Medicine

摘　　要：目的对比分析后外侧横突间植骨融合与经后路椎体间植骨融合术治疗腰椎不稳的疗效。方法 54例腰椎不稳患者分为横突间植骨融合组(A组)25例,椎体间植骨融合组(B组)29例。两组年龄、病程、术前临床表现及影像学资料相近似。A组大部分进行了后路椎板减压,B组全部进行了后路椎板减压,两组均进行了椎弓根钉系统复位与固定。结果 A组手术时间平均187 min,出血量平均640 mL,B组组手术时间平均250min,出血量平均980 mL,两组慢性下腰痛均明显改善,临床疗效两组间无显著性差异。骨融合率A组84%,B组96.5%(P=0.014);优良率A组88%,B组93.1%,两组无显著性差异(P>0.05)。结论横突间植骨与椎体间植骨是目前两种治疗腰椎退行性不稳症疗效确切的方法。两者治疗腰椎不稳的疗效相近,椎体间植骨融合率高,内固定失败率低,但手术创伤较大,失血较多。对没有神经根症状或神经根受压行"开窗"或半椎板切除的患者,横突间植骨不失为一种简便有效的植骨融合方式。对严重不稳定型椎管狭窄、椎体滑脱行全椎板切除患者,建议行椎间植骨融合。【Objective】To make a comparison of posterolateral intertransverse process fusion with posterior interbody fusion for lumbar instability.【Methods】54 patients with lumbar instability were treated with transverse interbody fusion（25 cases,group A）,and interbody fusion（29 cases,group B）.The age,duration,preoperative clinical data and imaging data was similar.Group A underwent posterior decompression,Group B underwent posterior decompression,both groups carried out a system reset and fixed.【Results】The average operative time was 187 min,the average amount of bleeding 640 mL for Group A,The average operative time was 250 min,the average amount of bleeding 980 mL for Group B,chronic low back pain were significantly improved in two groups.Bone fusion rate in group A was 84%,96.5% in Group B（P = 0.014）;excellent rate in group A was 88%,93.1% in group B（P 0.05）.【Conclusion】Intertransverse fusion and interbody fusion is currently the treatment of degenerative lumbar instability,the efficacy of these two treatment for lumbar instability is similar.I nterbody fusion has a low fixation failure rate,but more trauma and blood loss.For cases without nerve root symptoms or nerve root compression,posterolateral fusion is a simple and effective fusion method.For cases with severe unstable spinal stenosis,laminectomy with interbody fusion is recommended.

关 键 词：腰椎不稳定 后外侧横突间植骨融合 后路椎体间植骨融合 

分 类 号：R681.53[医药卫生—骨科学]