腰椎后路椎体间融合治疗椎间盘源性腰痛的疗效观察  

Posterior lumbar interbody fusion in the treatment of discogenic low back pain

作　　者：王华东[1] 侯树勋[1] 史亚民[1] 李利[1] 任东风[1] 

机构地区：[1]解放军总医院第一附属医院骨科,北京市骨科植入医疗器械工程技术研究中心,全军骨科研究所,北京100048

出　　处：《中国骨与关节杂志》2015年第12期969-972,共4页Chinese Journal of Bone and Joint

摘　　要：目的探讨腰椎后路椎体间植骨融合的手术技术,观察中、远期疗效并评价其在椎间盘源性腰痛治疗中的应用价值。方法对明确诊断椎间盘源性腰痛的71例患者行后路双侧椎板间开窗,椎弓根螺钉固定,单侧切除椎间盘,保留侧方及前方的纤维环,刮除终板的软骨层,植入足量的自体松质骨。术后不同随访时间观察症状改善及植骨融合情况。结果平均随访37.3（23-67）个月,原有症状改善,腰痛视觉模拟评分（visual analogue scale,VAS）术前（7.9±0.4）分,术后（1.1±0.3）分,改善率83.52%;Oswestry功能障碍指数（oswestry disability index,ODI）术前（61.7±5.5）分,术后（22.8±4.4）分,改善率72.66%。术后6-9个月移植骨间隙轮廓不清,CT示椎体与植入骨块交界处未见明显透亮区。其中12例影像学检查提示融合不良,植入骨块出现吸收,但术前症状获得改善。结论腰椎后路椎体间植骨融合术结合椎弓根固定是治疗椎间盘源性腰痛及腰椎稳定性重建的理想方法。Objective To study clinical results and surgical technique of posterior lumbar interbody fusion in the treatment of discogenic low back pain. Methods A total of 71 patients with discogenic low back pain underwent open discectomy and posterior lumbar interbody fusion with autograft from unilateral side with pedical screw instrumentations. Hospital records were reviewed for patients’ improvement of symptoms and fusion rate in different follow up periods. Results The mean follow up time was 37.3 months （ range： 23-67 months ）. Effective pain relief and functional improvement were obtained. Visual analogue scale （ VAS ）： （ 7.9±0.4 ） point preoperatively and （ 1.1±0.3 ） postoperatively （ improvement rate： 83.52% ）. Oswestry disability index （ ODI ）： （ 61.7±5.5 ） point preoperatively and （ 22.8±4.4 ） point postoperatively （ improvement rate： 72.66% ）. Bone graft gap contour was unclear 6-9 months postoperatively. CT showed no obvious bright areas in the junction of the vertebral bone and graft. Fusion failure was found in 12 cases, but preoperative symptoms were relieved significantly. Conclusions Posterior lumbar interbody fusion with pedical screw fixation is a sound method in the treatment of discogenic low back pain and it is also an ideal method to reconstruct the stability of the lumbar spine.

关 键 词：腰椎 脊柱融合术 骨移植 椎间盘 腰痛 矫形外科手术 

分 类 号：R687.3[医药卫生—骨科学]