自体骨与椎间融合器植骨融合治疗腰椎间盘突出并腰椎失稳的疗效  

Therapeutic effect of autologous bone and cage bone grafting on lumbar disc herniation and lumbar instability

作　　者：朱家佳 王源基 祝怡飞 张明生 ZHU Jiajia;WANG Yuanji;ZHU Yifei;ZHANG Mingsheng(The Second Affiliated of Zhengzhou Universi. ty,Zhengzhou 450014,China)

机构地区：[1]郑州大学第二附属医院

出　　处：《实用医学杂志》2019年第18期2918-2923,共6页The Journal of Practical Medicine

基　　金：河南省科技厅计划项目(编号:182102310550)

摘　　要：目的探讨自体骨环形植骨融合与椎间融合器(Cage)植骨融合两种方式结合椎弓根螺钉系统在治疗腰椎间盘突出症并腰椎失稳的临床疗效分析。方法回顾性分析2015年4月至2018年4月期间我院行手术治疗的腰椎间盘突出并腰椎失稳症患者85例,其中行单纯自体骨环形植骨者25例作为对照组(A组),60例行Cage植骨融合者作为观察组(B组)。术后随访15~18个月,平均(16.23±2.12)个月。比较两组患者手术时间、术中出血量、手术费用、术后融合率、脊柱稳定性、融合节段椎体成角、术前与术后相对椎间隙高度及功能恢复情况。采用JOA评分、ROM值及SUK融合标准进行评估。结果两组患者在手术时间、术中出血量及末次随访融合率比较无统计学差异(P> 0.05)。两组患者JOA评分、椎间成角及椎间隙相对高度(术后首次复查)比术前明显改善,有统计学意义(P <0.05),但两组间无明显差异(P> 0.05)。B组术后1个月JOA评分比A组高,但A组手术费用明显少于B组(P <0.05);A组术后3个月融合情况较B组强,但脊柱稳定性较B组差,差异有统计学意义(P <0.05);末次随访,两组植骨量均有丢失,但A组椎间隙相对高度较B组低,且成角更小,差异有统计学意义(P <0.05),但两组JOA评分及ROM值无差异(P> 0.05)。结论两种植骨方式结合椎弓根钉棒系统均可应用于治疗腰椎间盘突出并腰椎失稳症,症状改善明显,但自体骨融合从早期融合情况和经济效益来看更有优势,而Cage植骨融合更能保持脊柱长久稳定,可承担机体较高强度的活动。Objective To explore the clinical efficacy of autogenous bone grafting and interbody fusion(Cage)fusion with pedicle screw system in the treatment of lumbar disc herniation and lumbar instability. Methods A retrospective analysis of 85 patients with lumbar disc herniation and lumbar instability in our hospital from April 2015 to April 2018,including 25 patients with autologous bone grafting as control group(group A)60 cases of Cage bone graft fusion were used as observation group(group B). The patients were followed up for 15 to 18 months,with an average of(16.23 ± 2.12)months. The operation time,intraoperative blood loss,surgical cost,postoperative fusion rate,spinal stability,fusion segmental vertebral angle,preoperative and postoperative relative intervertebral space height and functional recovery were compared between the two groups. Evaluation was performed using JOA scores,ROM values,and SUK fusion standards. Results There was no significant difference in the operation time,intraoperative blood loss and the final follow-up fusion rate between the two groups(P >0.05). The JOA score,intervertebral angle and relative height of intervertebral space(first review after operation)were significantly improved in the two groups(P < 0.05),but there was no significant difference between the two groups(P > 0.05). The JOA score of group B was higher than that of group A after operation,but the operation cost of group A was significantly lower than that of group B(P < 0.05). The fusion of group A was stronger than that of group B after 3 months,but the stability of spine was better than that of group B. The difference was statistically significant(P < 0.05). At the last follow-up,the bone grafting loss was lost in both groups,but the relative height of intervertebral space in group A was lower than that in group B,and the angle was smaller,the difference was statistically significant(P < 0.05),but there was no difference between the two groups in JOA score and ROM value(P > 0.05). Conclusion Both the implanted bone metho

关 键 词：植骨融合 椎间盘突出 腰椎失稳 椎弓根螺钉系统 

分 类 号：R687.3[医药卫生—骨科学]