腰椎前路椎间自体骨植骨后椎间隙高度变化的研究  

Long-term follow-up on disc renarrowing after anterior lumbar interbody fusion with autogenous tricortical iliac crest graft

作　　者：张永刚[1] 张文智[2] 吕多赛[2] 陆瓞骥[2] 王岩[1] 梁智仁[2] 

机构地区：[1]解放军总医院骨科,北京100853 [2]香港大学骨科学系

出　　处：《中华外科杂志》2004年第6期330-333,共4页Chinese Journal of Surgery

摘　　要：目的　回顾性研究腰椎前路椎间自体骨植骨后临床与放射学的长期结果 ,观察自体骨塌陷的发生率及程度 ,评价与神经根疼痛复发的关系。　方法　对 6 7例采用自体髂骨进行L4,5椎间融合的患者进行了长期随访 ,平均随访时间为 14年 (2 5～ 32年 )。依据伸屈位X线片有无活动 ,X线断层片上植骨块与椎体是否存在透明线 ,以及有无骨性连接来判断椎间是否融合 ,同时测量椎间隙的高度 ;随访时根据患者的主述 ,检查患者有无下肢神经根刺激症状。　结果　在 6 7例随访患者中 ,6 4例获得了骨性融合 ,融合率为 96 % ,融合发生时间为 5～ 14个月 ,平均 9个月。在融合的 6 4例中 ,5 5例术后植骨块出现塌陷 ,发生率为 86 % ,9例没有出现塌陷 (14 % )。在出现植骨块塌陷的 5 5例中 ,术前椎间隙高度为 (12 1± 2 9)mm ,手术后增加到 (16 2± 1 9)mm ,至完全骨性融合时 ,椎间隙高度下降为 (12 9± 2 7)mm ,与最初的椎间隙高度没有显著差别。骨性融合后 ,椎间隙高度再无明显变化 ,最后随访时的高度为 (12 6± 2 3)mm。在整个随访过程中 ,95 %的患者 (5 2例 )没有复发神经根性疼痛。　结论　L4 5单节段椎间自体 3面皮质骨植骨后 ,容易出现植骨块塌陷 ,但是 ,椎间隙最终的高度很少低于术前最初的高度 ,且不会造成神经根?Objective To have a retrospective review of the patients undergoing anterior lumbar interbody fusion (ALIF) with clinical and radiological assessment,and observe changing of graft after procedure and assess correlation between graft collapse and recurrence of radioculopathy. Methods Sixty seven consecutive patients undergoing ALIF only at L 4～5 with autologous iliac crest graft for intervertebral disc prolapse were followed up for an average of 14 (2 5～32) years. The effect of the fusion was examined by the existence of radiolucent lines and bony continuity on plain radiographs and tomographs, or mobility on flexion extension radiographs. The disc height was also measured. Lower limb radiculopathy was assessed based on the symptom and examination. Paired samples t test was used for statistical analysis. Results Sixty four patients with successful fusion were analyzed (fusion rate: 96%). All measurements in this study were completed by the same author,and the measurement error of more than 2 mm was statistically significant. According to this, graft collapse occurred in 55 patients (86%) and 9 patients (14%) had no graft collapse. In these 55 cases, the original disc height was (12 1±2 9) mm, increased immediately after the surgery to (16 2±1 9) mm, however re narrowed to (12 9±2 7) mm at the first observation of solid fusion (a mean of 9 months, ranging from 5 to 14 months), which was not significant different compared to the original. There was no significant change in disc height after solid fusion and the disc space at the final follow up was (12 6±2 3) mm. There was no radiculopathy observed in 52 cases (95%) during the follow up. Conclusion Disc space re narrowing was observed in most cases after single level ALIF of L 4 5 , however it was rarely less than the initial and unlikely to result in recurrence of radiculopathy.

关 键 词：脊拄融合术 髂骨 自体移植 腰痛 

分 类 号：R687[医药卫生—骨科学]