同一患者应用自体骨植骨和椎间融合器行椎体间融合术治疗腰椎滑脱症的比较研究  

Comparison of clinical treatment for lumbar spondylolisthesis between two different methods of lumbar interbody fusion on the same case

作　　者：任磊[1] 孙永青[1] 郝敬东[1] 崔准[1] 

机构地区：[1]首都医科大学电力教学医院骨科,北京100073

出　　处：《中国骨与关节外科》2013年第5期397-402,共6页Chinese Journal of Bone and Joint Surgery

基　　金：2013年院级科研课题资助项目

摘　　要：背景：目前国内外公认椎体间融合术（PLIF）是治疗腰椎滑脱症的最佳手术方式,但椎间融合器的应用尚存争议。目的：比较同一患者应用自体骨植骨和椎间融合器行PLIF治疗不同节段腰椎滑脱症的临床疗效。方法：2008年3月至2012年1月收治两节段腰椎滑脱症患者61例,两个病变节段分别应用自体骨植骨和椎间融合器行腰椎后路PLIF。术前、术后和随访期间的日本骨科学会（JOA）下腰痛功能评分、Oswestry功能障碍指数（ODI）、视觉模拟评分（VAS）进行临床疗效评估;Tailland指数、Boxal指数、滑脱角、腰椎生理前凸角进行影像学疗效评估;Suk法进行椎间融合评估;测量比较各节段的椎间隙及椎间孔高度。结果：全部获得随访,随访时间为11~47个月,平均28.4个月。JOA评分治疗改善优良率为91.8%,术后JOA评分、ODI、VAS、Tailland指数、Boxal指数、滑脱角、腰椎生理前凸角均较术前明显好转（P〈0.01）,且末次随访无丢失（P〉0.05）。应用自体骨植骨的融合时间为（8.8±3.4）个月,融合率为93.4%;应用椎间融合器的融合时间为（9.4±2.9）个月,融合率为95.1%,两种椎间融合方式的融合时间及融合率相比较均无统计学差异（P〉0.05）。术后各腰椎间隙前缘高度、后缘高度、平均高度及椎间孔高度均较术前明显提高（P〈0.01）,但两种椎间融合方式术前和术后的腰椎间隙前缘高度、后缘高度、平均高度及椎间孔高度相比较无统计学差异（P〉0.05）。自体骨植骨椎间融合方式末次随访的椎间隙前缘高度、平均高度及椎间孔高度与术后比较丢失明显（P〈0.05）。结论：两种椎间融合方式均获得良好的临床疗效及椎间融合,而椎间融合器在维持椎间高度方面表现优异,其联合前方自体骨植骨可以作为PLIF的理想椎间融合选择。Background： It has been generally acknowledged that Lumbar Interbody Fusion （LIF） is the most effective therapy for lum- bar spondylolisthesis, but the use of interbody fusion cage remains controversial. Objective： To compare the clinical efficacy of autogenous bone grafting and interbody fusion cage in treating different seg- ments of lumbar spondylolisthesis on the same case. Methods： From March 2008 to January 2012, 61 patients with two-segments lumbar spondylolisthesis were treated in our hospital. These two segments were treated respectively with autogenous bone grafting and interbody fusion cage by posteri- or lumbar interbody fusion. At the preoperative, postoperative and follow-up stage respectively, the Japanese Orthopaedic Association （JOA） scores of the lower back pain, Oswestry Disability Index （ODI）, and Visual Analogue Scale （VAS） were recorded for clinical evaluation; the Tailland indexes, Boxal indexes, slipping angles, and lumbar lordosis angles were re- corded for radiographic evaluation; the Suk standard was adopted for efficacy evaluation; and the height of intervertebral space and foramen of segments were measured and compared. Results： All the 61 cases were followed up, the mean follow-up period was 28.4 （11-47） months. The excellent and good rate of the JOA improvement was 91.8%. The JOA scores of the lower back pain, ODI, VAS, Tailland indexes, Boxal index- es, slipping angles, and lumbar lordosis angles at the postoperative stage were all significantly improved compared to the preoperative stage （P〈0.01）, and there was no loss of the scores at the last follow-up （P〉0.05）. The fusion time of the fora- men of the autogenous bone grafting was （8.8±3.4） months, the fusion rate was 93.4%, and the fusion time of the foramen of interbody fusion cage was （9.4±2.9） months, and the union rate was 95.1%. There was no statistical difference between ei- ther fusion time or rate of the two methods （P〉 0.05）. Lumbar intervertebral height of anterio

关 键 词：腰椎滑脱 椎体间融合术 椎间融合器 自体骨 

分 类 号：R687.3[医药卫生—骨科学]