不同自体骨源椎间植骨融合术治疗退变性腰椎滑脱  

Different autologous bone sources in posterior lumbar interbody fusion for degenerative spondylolisthesis

作　　者：项力源[1] 刘兰泽[1] 

机构地区：[1]唐山市第二医院脊柱外科,河北唐山063000

出　　处：《临床骨科杂志》2015年第5期570-573,共4页Journal of Clinical Orthopaedics

摘　　要：目的：比较棘突椎板和髂骨两种自体骨源行椎间植骨融合（ PLIF）治疗退变性Ⅰ度腰椎滑脱的临床疗效。方法将50例单节段Ⅰ度腰椎滑脱患者随机分为两组,棘突椎板植骨（ A组）28例,自体髂骨植骨（ B组）22例。比较两组手术时间、术中出血量、融合情况及并发症。结果两组患者均顺利完成手术。所有患者均获随访,时间10~16个月。 A 组手术时间及术中出血量均明显低于 B 组,差异有统计学意义（ P 〈0．05）。伤口愈合时间、滑脱率、椎间高度和节段角度等指标两组比较差异无统计学意义（P〉0．05）。末次随访时A组23例、B组19例达骨性愈合,融合率分别为82．14%（23/28）和86．36%（19/22）,差异无统计学意义（P〉0．05）。术后两组JOA评分均较术前增加（P〈0．05）,组间比较差异无统计学意义（P〉0．05）。并发症发生率：A组为3．57%（1/28）,B组为63．63%（14/22）,差异有统计学意义（P〈0．01）。结论取棘突椎板与髂骨对单节段PLIF临床效果相当,前者操作简便、创伤小、不良反应少,是一种值得临床推广的骨源。Objective To compare the clinical efficacy of local bone graft and autologous iliac bone for posterior lum-bar interbody fusion （ PLIF） in the treatment of degreeⅠdegenerative spondylolisthesis. Methods 50 patients with single segment degreeⅠspondylolisthesis were divided into two groups randomly. Group A were adminstered PLIF with local bone graft （n=28） and group B with autologous iliac bone （n=22）. Operative time, blood loss, bone union rate and complications were compared between two groups. Results All patients were operated successfully. All patients were followed up for 10~16 months. Operative time and blood loss of group A was lower than group B significantly, the difference was statistically significant （ P〈0. 05 ） . There was no significant difference in wound healing time, slip rate, intervertebral height and intervertebral angle between two groups （P〉0. 05）. At the end of follow-up, there were 23 and 19 cases of osseous healing in group A and group B. Fusion rate were 82. 14%（23/28） and 86. 36%（19/22） respectively （P 〉0. 05）. JOA scores were increased compared to the preoperative （P 〈0. 05）, but no significant difference between two groups （P〉0. 05）. The incidence of complications was 3. 57%（1/28） and 63. 63%（14/22） in the group A group B respectively, the difference was statistically significant （ P〈0. 01）. Conclusions Both local bone graft and iliac bone graft on the single segment PLIF perform effectively. Iliac bone graft is easy to operate with less invasion and less adverse reactions, which is worthy to promote.

关 键 词：腰椎滑脱 椎间植骨融合 棘突椎板 髂骨 

分 类 号：R681.5[医药卫生—骨科学] R687.3[医药卫生—外科学]