腰椎终板间自体骨粒移植融合术治疗中老年腰椎失稳腰椎脱位  

Lumbar intervertebral endplate autograft fusion for the treatment of vertebral dislocation in the elderly

作　　者：张舜[1] 陈坤峰[2] 郭旗[1] 张雷[1] 段广超[1] 南运东[1] 张传林[1] Zhang Shun;Chen Kunfeng;Guo Qi;Zhang Lei;Duan Guangchao;Nan Yundong;Zhang Chuanlin(Department of Orthopaedics,First People′s Hospital of Shangqiu City(First People′s Hospital of Shangqiu City,Affiliated to Xinxiang Medical),Shangqiu 476100,China;Department of Emergency Surgery,First People′s Hospital of Shangqiu City(First People′s Hospital of Shangqiu City,Affiliated to Xinxiang Medical University),Shangqiu 476100,China)

机构地区：[1]河南省商丘市第一人民医院(新乡医学院附属商丘第一人民医院)骨二科,476100 [2]河南省商丘市第一人民医院(新乡医学院附属商丘第一人民医院)急诊外科,476100

出　　处：《中华实验外科杂志》2021年第7期1364-1369,共6页Chinese Journal of Experimental Surgery

基　　金：河南省科技攻关计划项目(112102310685)。

摘　　要：目的:探讨中老年腰椎终板间自体骨粒移植融合术治疗腰椎失稳腰椎脱位的疗效,并与目前临床常用的腰椎间融合器植骨融合术比较。方法:分析2011年6月至2018年6月商丘市第一人民医院收治的42例中老年腰椎失稳腰椎脱位患者临床资料,其中男26例,女16例,年龄(50.6±3.7)岁,其中21例行腰椎复位内固定+椎板切除椎管减压+终板间自体骨粒移植融合术(终板组),另21例行腰椎复位内固定+椎板切除椎管减压+椎体间融合器植骨融合术(对照组)。术后两组比较手术时间、术中失血量、术中术后输血例数及输血量、术后引流量、引流管拔除时间、术后终板间隙及腰椎前曲度,术后配支具下床时间。术后2年内固定去除时比较两组终板间隙CT平描融合面积占终板面积百分比、终板间隙高度因承压承旋下降值、腰椎前曲度下降值、移植物松动退出例数、改良日本骨科学会(JOA)腰背痛评分。比较术后约3、6个月、1、及2年时内固定去除时两组X线像显示的骨痂生成速度及融合质量。结果患者资料收集范围均分别为住院病历资料、随访资料及内固定去除时病历资料,其中内固定去除时间为术后(23.6±2.2)个月。结果:两组手术时间(123.6±30.4)、(141.7±28.4)min,术后失血量(164.3±50.7)、(193.4±60.8)ml,术中术后输血例数14例、15例(两组每例均2 U),术后引流量(350.1±72.4)、(390.3±99.1)ml,引流管拔除时间(73.0±0.6)、(74.0±1.90)h,术后终板间隙(12.6±0.2)、(11.9±1.0)mm,腰椎前曲度(16.1±1.0)°、(15.8±1.9)°,配支具下床时间(7.6±0.9)、(6.8±0.5)d比较,差异均无统计学意义(P>0.05)。术后约2年时两组CT平描终板间隙融合面积占终板面积百分比分别为(78.2±21.7)%、(39.8±13.7)%,移植物松动退出分别为0例、1例,终板间隙下降值分别为(1.2±0.3)、(1.8±0.6)mm,腰椎前曲度下降值分别为(1.1±0.2)°、(1.9±0.9)°,JOA腰背痛评分分别为(0.76±10.7Objective To investigate the effect of lumbar endplate autograft fusion in the treatment of elderly patients with lumbar instability and dislocation,and compare it with interbody fusion cage bone graft fusion commonly used.Methods We analyzed 42 middle-aged and elderly patients with lumbar traumatic vertebral dislocation admitted to Shangqiu First People′s Hospital(First People′s Hospital of Shangqiu Affiliated to Xinxiang Medical College)from June 2011 to June 2018.There were 26 males and 16 females,aged[(50.6±3.7)]years old.Inclusion criteria were as follows:Lumbar instability was verified by lateral X-ray showing anterior flexion-posterior extension displacement≥3 mm and angle of upper and lower endplates≥15°.Lumbar dislocation wasⅠtoⅡdegree according to Meyerding classification.The number of lumbar reduction internal fixation+laminectomy decompression+endplate autograft fusion(endplate group)was 21,and the number of lumbar reduction internal fixation+laminectomy decompression+intervertebral fusion graft fusion(control group)was also 21.The operation time,bleeding,blood transfusion,drainage,extubation time,endplate space&lumbar anterior angle and brace removal time were recorded in the two teams after surgery.At 2nd year after surgery,the graft was removed.The percentage of fusion area in the endplate space(CT),the decrease of endplate space&lumbar anterior angle,the number of quit caused by the graft loosening and Japanese Orthopaedic Association Scores(JOA)score were compared.In addition,the rates of callus formation and fusion quality at 3rd and 6th month,1st year and 2nd year after surgery were analyzed.Results The clinical data of patients collected contained the medical record,follow-up data and the medical record of internal fixation removal.The removal time was[(23.6±2.2)]months after the surgery.There were no statistically significant differences between the two groups in operation time[(123.6±30.4)vs.(141.7±28.4)min],bleeding[(164.3±50.7)and(193.4±60.8)ml],blood transfusion[14 case

关 键 词：腰椎 脱位 移植 椎体终板 

分 类 号：R687.3[医药卫生—骨科学]