自体椎板关节突柱状植骨融合治疗腰椎退行性疾病的疗效分析  

Analysis of treatment of harvesting cylinder autograft interbody fusion from local vertebral laminae and zygapophysis for lumbar degenerative disease

作　　者：万标林[1] 梁伟国[1] 王斌[1] 周子强[1] 吴劲风[1] 陈志光[1] 

机构地区：[1]暨南大学第四附属医院广州市红十字会医院骨科,广州510220

出　　处：《中国矫形外科杂志》2012年第11期964-967,共4页Orthopedic Journal of China

基　　金：广东省自然科学基金面上项目(编号:10151022001000005);广州市医药卫生科技重点项目(编号:2009-Zdi-05)

摘　　要：[目的]通过与同种异体+自体骨融合比较,探讨术中整块切除椎板关节突裁制柱状植骨融合治疗退行性腰椎退行性疾病的临床疗效。[方法]对本院2008年10月～2011年11月采用术中整块切除椎板关节突裁制柱状植骨块与同种异体+自体骨融合治疗的62例腰椎退变患者进行回顾性分析,其中A组(椎弓根螺钉固定与自体柱状骨融合,自体柱状骨组)28例,B组(椎弓根螺钉固定与同种异体+自体骨融合,同种异体+自体骨组)34例,比较两种治疗方法在手术时间、术中出血量、手术切口大小、住院天数、手术费用、住院总费用等的差异。通过JOA评分、术后1年融合率等指标来评价两种治疗方法的疗效。[结果]术后随访20～35个月,平均26.3个月。A组与B组手术材料费和住院总费用比较有差异(P<0.05),A组比B组少;两组患者在手术时间、术中出血量、手术切口、住院天数、术后1年融合率无明显差异(P>0.05)。两组患者术后各时间点JOA评分较术前比较有差异(P<0.05),组间比较无明显差异(P>0.05)。A组未见明显并发症,B组术后有2例伤口周围红肿、白细胞升高及1例脑脊液漏。[结论]通过与同种异体骨+自体骨融合比较,术中整块切除椎板关节突裁制柱状椎体间植骨块作为植骨材料,植骨融合界面大,椎间融合率高,临床疗效好,是一种安全、方便、经济和实用的临床技术。[Objective]To explore clinical effect of treatment of harvesting cylinder autograft interbody fusion from local vertebral laminae and zygapophysis for lumbar degenerative disease.[Methods]Sixty-two lumbar degenerative illness patients in a retrospective study were treated with bone graft interbody fusion from October 2008 to November 2011,twenty-eigtht patients were treated as group A（pedicle screws fixation with autograft column bone,autologous cylinder bone group）,and thirty-four patients were as group B（pedicle screws fixation with allogenic bone plus autologous bone,allogenic bone plus autologous bone group）.The difference of two groups were evaluated with operation time,intraoperative blood loss,hospital stay time,size of operative incision,cost of operation,total expense of hospital stay.The clinical effects of two groups were evaluated by JOA scores and postoperative one year fusion rate.[Results]All cases were followed up for 20 to 35 months（average,26.3 months）.The cost of operation and total expense of hospital stay showed statistic difference（P〈0.05）,which were lower in group A.There were no significant differences between the two groups in operation time,intraoperative blood loss,size of operative incision,hospital stay time and postoperative one year fusion rate（P〈0.05）.Both the two groups showed statistic difference between postoperative JOA scores and preoprative JOA scores（P〈0.05）,but the JOA scores had no significant difference between the two groups at the same time point.There was no obvious complication in group A,but red swelling aroud the incision and increased leukocyte count occurred in two patients,and postoperative cerebrospinal fluid leakage occurred in one patient in group B.[Conclusion]Compared with allogenic bone plus autologous bone interbody fusion,cutting the whole local vertebral laminae and zygapophysis into cylinder bone block as bone graft material has large interface of fusion,high interbody fusion rate,and more patients with excellent clinical o

关 键 词：植骨融合 柱状自体骨移植 同种异体骨移植 腰椎退行性疾病 

分 类 号：R687.3[医药卫生—骨科学]