同种异体骨、Cage与自体髂骨在椎间植骨融合术治疗颈椎间盘突出症中的应用比较  

Application of Allogeneic Bone, Cage and Autogeneic Ilium in the Interbody Fusion of Cervical Disc Herniation

作　　者：王玉召[1] 曹鎏[1] 王铀 罗飞[2] 钟浩 赵志明 张岩峰 苟瑞锐 WANG Yu-zhao;CAO Liu;WANG You;LUO Fei;ZHONG Hao;ZHAO Zhi-ming;ZHANG Yan-feng;GOU Rui-rui(Department of Orthopedics,the 948th Hospital of PLA Army,Wusu,the Xinjiang Uygur Autonomous Region 833000,China;Department of Orthopedics,Southwest Hospital of the Third Military Medical University,Chongqin 400038,China)

机构地区：[1]中国人民解放军陆军第九四八医院骨科,新疆维吾尔自治区乌苏833000 [2]第三军医大学西南医院骨科,重庆400038

出　　处：《临床误诊误治》2020年第5期69-74,共6页Clinical Misdiagnosis & Mistherapy

基　　金：西南医院临床医学创新基金(SWH2013LC23)。

摘　　要：目的比较同种异体骨、Cage与自体髂骨在椎间植骨融合术治疗颈椎间盘突出症中的应用效果。方法选取行椎间植骨融合术的颈椎间盘突出症84例,根据手术植骨所用材料不同将其分为同种异体骨组(26例)、Cage组(22例)和自体髂骨组(36例)3组。观察比较3组围术期相关指标,术前及术后3 d、3个月、6个月颈部疼痛程度,术后3个月并发症发生情况,术后3和6个月骨融合情况,术后6个月椎间高度和颈椎曲度,以及术后6个月治疗效果。结果 3组手术时间、术中出血量及术后住院时间总体比较差异均有统计学意义(P<0.05或P<0.01);自体髂骨组手术时间和术中出血量长于或多于同种异体骨组,手术时间、术中出血量及术后住院时间长于或多于Cage组,差异均有统计学意义(P<0.01)。术后6个月,3组颈部视觉模拟评分法评分总体比较差异有统计学意义(P<0.01);自体髂骨组颈部视觉模拟评分法评分高于同种异体骨组,差异有统计学意义(P<0.01)。术前及术后3 d、3个月、6个月,3组组内颈部视觉模拟评分法评分总体比较差异均有统计学意义(P<0.01)。术前及术后3 d、3个月、6个月,3组组内颈部视觉模拟评分法评分均呈依次下降趋势,组内不同时间点两两比较差异均有统计学意义(P<0.05或P<0.01)。3组术后3个月并发症发生率总体比较差异有统计学意义(P<0.05)。自体髂骨组术后3个月并发症发生率显著高于同种异体骨组和Cage组,差异有统计学意义(P<0.05)。3组术后3和6个月骨融合率、术后6个月椎间高度和颈椎曲度以及术后6个月Odom分级总体比较差异均无统计学意义(P>0.05)。结论同种异体骨、Cage及自体髂骨应用于椎间植骨融合术治疗颈椎间盘突出症中均具有较好效果,但采用自体髂骨者损伤大、痛苦较多,采用Cage者可能发生金属反应,而采用同种异体骨者并发症相对较少、安全性较高。Objective To compare the application effects of allogeneic bone, Cage and autogeneic ilium in the interbody fusion of cervical disc herniation(CDH). Methods Eighty-four patients with CDH who underwent interbody fusion were divided into allogeneic bone group(n=26), Cage group(n=22) and autogeneic ilium group(n=36) according to the different bone grafting materials. The perioperative related indicators, neck pain level before surgery and at 3 d, 3 months and 6 months after surgery, occurrence of postoperative complications at 3 months after surgery, bone fusion at 3 months and 6 months after surgery, intervertebral height and cervical curvature at 6 months after surgery and therapeutic effects at 6 months after surgery were observed and compared among the three groups. Results There were significant differences in the duration of operation, intraoperative blood loss and postoperative length of hospital stay among the three groups(P<0.05 or P<0.01). The duration of operation and intraoperative blood loss in autogeneic ilium group were longer or larger than those in allogeneic bone group, and the duration of operation, intraoperative blood loss and postoperative length of hospital stay were longer or larger than those in Cage group(P<0.01). At 6 months after surgery, there was a statistically significant difference in the overall neck visual analogue scale(VAS) score among the three groups(P<0.01). The neck VAS score in autogeneic ilium group were higher than those in allogeneic bone group(P<0.01). Before surgery and at 3 d, 3 months and 6 months after surgery, there was a statistically significant difference in the overall neck VAS score among the three groups(P<0.01). Before surgery and at 3 d, 3 months and 6 months after surgery, the neck VAS score in the three groups all showed a downward trend in order, and the difference within groups was statistically significant at any two time points(P<0.05 or P<0.01). There was a statistically significant difference in the incidence rate of postoperative complications at 3

关 键 词：椎间盘移位 颈 脊柱融合术 同种异体骨 CAGE 自体髂骨 骨融合 椎间高度 颈椎曲度 

分 类 号：R687.3[医药卫生—骨科学]