后路固定椎间碎骨植骨与髂骨块植骨融合术治疗退行性腰椎不稳的临床研究  

Clinical study of posterior internal fixation and iliac crest or granular bone grafting lumbar interbody fusion for the treatment of the degenerative lumbar instability

作　　者：林斌[1] 林秋燕[1] 邵泽豹[1] 

机构地区：[1]解放军第175医院骨科,福建漳州363000

出　　处：《中国矫形外科杂志》2012年第17期1551-1555,共5页Orthopedic Journal of China

摘　　要：[目的]对比研究后路椎间碎骨植骨与自体髂骨块植骨两种融合术治疗腰椎退行性不稳的临床疗效。[方法]75例患者,男41例,女34例;年龄27～68岁,平均55.6岁。临床表现:下腰痛72例,间歇性跛行47例;75例患者均有下肢痛,其中单侧下肢痛37例,双侧下肢痛23例,交替性双下肢痛15例;直腿抬高受限57例,感觉障碍66例,运动障碍58例,膝、跟腱反射异常45例,伴马尾损害23例。退变节段:L4、532例,L5S126例,L3、46例,2个间隙11例。将病例随机分为髂骨组和碎骨组,髂骨组行腰椎后路减压椎弓根固定+自体髂骨椎间融合(pedicalscrew fixation+iliac crest grafting)治疗,碎骨组行腰椎后路减压椎弓根固定+碎骨椎间融合(pedical screw fixation+granular bone grafting)。两组分别于术前,术后3、6、12个月测定JOA(Japanese Orthopaedics Association)腰背痛手术评分和ODI(oswestry disability index)评分,并对术后融合情况进行评估。[结果](1)各组术前、术后JOA、ODI评分有显著差异,而两组之间评分无明显差异;(2)各组术前、术后椎间隙高度有显著差异,术后两组之间比较碎骨组椎间隙高度丢失相对较多,有统计学差异;(3)各组术前、术后椎间隙活动度有显著差异,两组之间比较椎间隙活动度无明显差异;(4)两组中植骨块与上下终板交界处无透亮区;随访影像学检查示椎间植骨融合良好,螺钉无折断和松动,未发现植骨块脱入椎管。[结论]两组在术后融合时间、融合率及临床症状缓解程度上无显著差异。但碎骨植骨在手术时间、出血量等方面优于髂骨组,而且无取髂骨处遗留痛等并发症。碎骨植骨椎间融合是治疗腰椎退行性不稳的一种有效手术方法。[ Objective ] To compare the clinical outcome of posterior pedicle screw fixation and iliac crest or granular bone grafting lumbar interbody fusion for the treatment of degenerative lumbar instability. [ Methods ] There were 75 patients with de- generative lumbar disease. They were 41 males and 34 females, aged from 27 to 68 years with an average of 55.6 years. Clinical manifestation： there were 72 cases with lower back pain and 47 cases with intermittent claudication. All of 75 cases had leg pain, including 37 cases of unilateral leg pain, 23 cases of bilateral leg pain and 15 cases of alternative leg pain. Fifty - seven cases were positive with straight leg raising test, 66 cases had sensory disturbance, 58 cases had movement disorders, and 45 cases had abnormal achilles tendon reflex and knee jerk reflex, and 45 cases had injuries of cauda equina. There were 32 cases with degeneration of L4,5 , 26 cases with degeneration of L5 $1, 6 cases with degeneration of L3,4, and 11 cases with degenera- tion more than 2 segments. They were divided into two groups randomly ： iliac bone group and granular bone group. The iliac bone group were treated with decompression, internal fixation for degenerative lumbar instability with pedicle screw and interbody fu- sion with iliac crest grafting. The granular bone group were treated with decompression, internal fixation and with granular bone grafting fusion. All of the cases had X - ray in routine and oblique view, CT and MRI preoperatively. The Japanese Orthopedic Association （JOA） score, Oswestry Disability Index （ODI） were evaluated before and 3, 6, 12 months after surgery. And fu- sion situation was evaluated by reviewing the roentgenographic film. [ Results ] （ 1 ） Significant difference of JOA score and ODI were founded in each gToup before and after surgery. But it was no significant different between two groups. （2） The loss ofintervertebral height was significant different between two group before and after surgery. The loss of intervertebral height

关 键 词：退行性腰椎不稳 椎间融合术 碎骨 髂骨 

分 类 号：R687.3[医药卫生—骨科学]