腰椎植骨融合内固定术中植骨粒体积对术后融合效果的影响  

Effect of intraoperative intervertebral bone grafting particle volume on postoperative intervertebral fusion in posterior lumbar pedicle screw fixation

作　　者：郝建学[1] 周斐[2] 王明昊[1] 张建鹏[1] 任康[1] 邸丽萍[3] 陈美青[1] 刘锁利[1] 万建设[1] 

机构地区：[1]河北省保定市第一医院骨外科,河北保定071000 [2]承德医学院研究生院,河北承德067000 [3]河北省保定市第一医院妇产科,河北保定071000

出　　处：《中国现代医学杂志》2015年第15期67-70,共4页China Journal of Modern Medicine

摘　　要：目的探讨腰椎后路椎弓根钉内固定配合植骨融合及椎间融合器术中椎间植骨粒体积与术后融合效果的关系。方法选择在河北省保定市第一医院行椎弓根钉棒系统内固定配合Cage植骨融合术的病例共82例,随机分为三组,术中分别植入不同体积的植骨粒。其中A组28例,植骨粒体积平均为0.2 cm3;B组27例,植骨粒体积平均为0.1 cm3;C组27例,植骨粒体积平均为0.05 cm3。对三组患者植骨粒体积、临床效果、植骨融合率、椎间隙高度等进行比较。结果三组植骨粒体积比较差异有统计学意义(P<0.05),但椎间植骨总体积及Cage高度比较差异无统计学意义(P>0.05)。末次随访时,各组下腰痛、双下肢疼痛视觉模拟评分(VAS)及功能障碍指数(ODI)均较术前显著降低(P<0.05),但组间比较差异均无统计学意义(P>0.05)。术后1、2年植骨融合率B组均显著高于A、C组,A组高于C组(P<0.05)。末次随访时B组椎间隙高度变化显著小于A、C组(P<0.05)。结论采用不同植骨粒体积在术后患者症状改善方面没有明显差异,但中等体积植骨粒(0.1cm3/粒)可明显提高术后椎间融合率,减小了椎间隙高度丢失。[ Objective ] To investigate the effect of posterior lumbar pedicle screw fixation combined with bone graft fusion and the relationship between intraoperative intervertebral bone grafting particle volume and postoperative intervertebral fusion. [ Methods ] Totally 82 patients in the First Hospital of Baoding City for pedicle screw rod sys- tem fixation with cage and bone graft fusion were chosen, and divided into three groups according to the implanted volume of bone grains. The averaged bone grain volume was 0.2 cm3 in group A （28 cases）, 0.1 cm3 in group B （27 cases） and 0.05 cm3 in group C （27 cases）. The bone grain volume, clinical effect, bone graft fusion rate and inter- vertebral height in the three groups were compared. [ Results ] There were statistically significant differences in bone grain volume between the three groups （P 〈 0.05）, but the intervertebral bone volume and height of cage showed no significant differences （P 〉 0.05）. At the end of the follow-up, the lower back pain, lower extremity pain visual ana-logue scale （VAS） and disability index （ODI） were significantly decreased in each group （P 〈 0.05）, the differences between the groups were not statistically significant （P 〉 0.05）. One to two years after operation, bone fusion rate of the group B was significantly higher than those of the groups A and C, that in the group A was significantly higher than in the group C （P 〈 0.05）. At the last follow-up, the intervertebral height change in the group B was less than those in the groups A and C （P 〈 0.05）. [ Conclusions ] There is no significant difference in improving symptoms af- ter operation of different bone graft seed volume, but the medium-sized bone graft particles （0.1 cm3/particle） can significantly improve the postoperative intervertebral fusion rate and reduce loss of the intervertebral height.

关 键 词：椎间植骨 脊柱融合 内固定 融合效果 

分 类 号：R681.5[医药卫生—骨科学]