新型腰椎后路植骨方法的临床应用及近期疗效观察  

Clinical application of a novel posterior lumbar fusion method and the short-term observation of its effect

作　　者：闫景龙[1] 奚春阳[1] 张志鹏[1] 徐公平[1] 夏景君[1] 王新涛[1] 周磊[1] 祖佳宁[1] 姬烨[1] 

机构地区：[1]哈尔滨医科大学附属第二医院骨科,150081

出　　处：《中华外科杂志》2014年第10期750-753,共4页Chinese Journal of Surgery

基　　金：国家自然科学基金资助项目（81071488）;黑龙江省科技攻关计划资助项目（GC10C303-1）

摘　　要：目的 从增加骨移植物局部血供入手,建立一种带有原位椎旁肌肌骨瓣的新型腰椎后路植骨方法,观察其早期应用的植骨融合率,评估该方法的临床疗效.方法 2007年6月至2010年12月,应用新型植骨法对117例腰椎管狭窄和腰椎失稳的患者行腰椎管减压植骨融合内固定治疗,其中男性49例,女性68例,年龄40～77岁,平均61.5岁;所有患者术前及术后均进行日本骨科学会（JOA）及视觉模拟量表（VAS）评分,评价临床疗效,同时术后应用CT三维重建评价植骨融合效果.结果 术后失访17例,其余病例随访7～38个月,平均19个月.术前JOA评分平均（10.3±1.9）分,末次随访时平均（25.4±4.2）分,与术前相比差异具有统计学意义（P＜0.01）,改善率81.0％;术前下肢VAS评分为平均（8.5±0.8）分,术后为平均（2.3±0.4）分,术前、术后相比差异具有统计学意义（P＜0.01）.术后CT三维重建显示,获得随访的100例患者的133个腰椎节段中,126个节段形成了坚固融合,融合率94.7％.结论 新型腰椎后路植骨方法植骨位置确切、牢靠、融合率高,能够有效减少假关节的形成,疗效确切,具有良好的临床应用前景.Objective To increase local blood supply of bone graft,a novel posterior lumbar spine fusion method with orthotopic paraspinal muscle-pediculated bone flaps was constructed,and the fusion rate and clinical effect.were observed.Methods From June 2007 to December 2010,117 patients of lumbar spinal stenosis or lumbar destabilization treated with the novel posterior lumbar fusion method were studied,49 males and 68 females,aged from 40 to 77 years,average 61.5 years.Clinical effect was evaluated by JOA and VAS score preoperatively and postoperatively,and the fusion result was evaluated by threedimensional CT reconstruction postoperatively.Results Seventeen cases lost of follow up,the rest were followed up from 7 to 38 months,average 19 months.There was significant difference between pre-and postoperative JOA and VAS score （P 〈0.01）,the preoperative JOA score was 10.3 ± 1.9,and 25.4 ±4.2 at the latest follow-up,the improvement rate was 81.0% ; the preoperative VAS score was 8.5 ±0.8,and 2.3 ± 0.4 at the latest follow-up.The three-dimensional CT reconstruction showed that 126 of the 133 segments formed solid fusion in 100 patients who completed the follow-up,the fusion rate was 94.7%.Conclusion The novel posterior lumbar fusion method make the bone graft position more precise,stable and increases the fusion rate,which can effectively reduce pseudarthrosis and have a promising clinical effect.

关 键 词：腰椎融合 椎旁肌 肌骨瓣 植骨融合 

分 类 号：R687.3[医药卫生—骨科学]