改良TLIF同时使用自体骨植骨与椎间融合器治疗双节段退变性腰椎不稳的初期疗效分析  

Comparison of primary clinical efficacy for modified TLIF surgery while using autogenous bone grafting and interbody fusion cage for two-levels degenerative lumbar instability

作　　者：钟华璋 田大胜[1] 周云[1,2] 荆珏华[1] 钱军[1] 陈磊[1] 江曙[3] 

机构地区：[1]安徽医科大学第二附属医院骨科,合肥230601 [2]安徽医科大学第二附属医院康复医学科,合肥230601 [3]安徽医科大学第一附属医院骨科,合肥230022

出　　处：《安徽医科大学学报》2016年第3期393-398,共6页Acta Universitatis Medicinalis Anhui

基　　金：安徽省自然科学基金面上项目(编号:1408085MH184)

摘　　要：目的分析在应用改良TLIF治疗双节段退变性腰椎不稳中自体骨块和椎间融合器放置不同病变节段的初期临床疗效。方法 33例双节段退变性腰椎不稳患者均行改良TLJF联合后路内固定系统治疗。Ⅰ组上位病变节段自体骨植骨联合下位病变节段椎间融合器14例;Ⅱ组上位病变节段椎间融合器联合下位病变节段自体骨植骨19例。术前、术后、末次随访采用Oswestry功能障碍指数(ODI)、视觉模拟评分法(VAS)、日本骨科学会(JOA)下腰痛功能评分行临床疗效评估;测量计算椎间孔高度、腰椎生理前凸角及椎间隙平均高度作为影像学评价标准;融合情况采用Suk标准判断。结果两组间性别、随访时间、病种比例、年龄等一般资料以及术前各项参数比较差异无统计学意义。两组术后各项参数均较术前明显改善(P<0.05)。Ⅰ组植骨节段术后与末次随访的椎间隙平均高度、椎间孔高度均较Ⅱ组改善明显,两组间其余术后与末次随访的各项参数之比差异均无统计学意义。所有病例所有节段达到骨性融合,两组植骨节段融合时间分别为(5.42±1.40)、(5.53±1.12)个月,融合器节段融合时间分别为(6.86±1.61)、(6.26±1.41)个月,差异无统计学意义。结论改良TLIF同时使用自体骨植骨与椎间融合器的临床治疗效果明显,其中上位病变节段自体骨植骨联合下位病变节段椎间融合器能取得更满意的初期临床疗效。Objective To compare the primary clinical results of interbody fusion cage placed in different lesion segments when using the modified transforaminal lumbar interbody fusion （TLIF） surgery to cure two segment degenerative lumbar instability. Methods Data of 33 two segments degenerative lumbar instability patients who had undergone modified TLIF surgery with posterior fixation system were retrospectively analyzed. According to the different fusion methods, all patients were divided into 1 and II groups. 14 patients in group I were treated by superior bone grafting and lower interbody fusion cage; 19 patients in group II were treated by superior interbody fusion cage and lower bone grafting. At the preoperative , postoperative and follow-up stage respectively, the oswestry disability index （ODI）, visual analogue scale （VAS）, Japanese orthopaedic association （JOA） scores of the lower back pain were recorded for clinical evaluation. The foraminal height, lumbar lordosis angle and calculate the average height of the intervertebral space for radiographic evaluation; the Suk standard was adopted for fusion efficacy evaluation. Results All the 33 cases were followed up . There were no significant differences in gender, follow-up time, the proportion of disease, age and all preoperation indexes between two groups. All the indexes of postoperation were significantly improved compared with preoperation in the two groups. The average and foraminal height of intervertebral space at the postoperative and the last follow-up stage in bone grafting segments of group I improved significantly than group II. But other indexes at the postoperative and the last follow-up stage in the two groups showed no significant differences. For the fusion time, autogenous bone grafting was （5.42 ± 1.40） months and cage was （6. 86 ± 1.61） months in group I , and in group II it was （5.53 ±1.12） months and （6.26 ± 1.41 ） months repeetively. There were no statistical differences in fusion time between group I and I

关 键 词：退变性腰椎不稳 脊柱外科 椎间融合 植骨融合 椎间融合器 

分 类 号：R681.533[医药卫生—骨科学] R687.37[医药卫生—外科学]