后路椎体间打压植骨治疗老年人腰椎退变性疾病的临床报道

Clinical outcomes of bone graft and impaction on posterior interbody fusion for senile lumbar degeneration

目的探讨椎体间微粒骨打压植骨治疗老年人腰椎退变性疾病的手术技术和初期临床疗效报道.方法本组为2002年5月～2004年8月在对28位60岁以上老年人腰椎退变性疾病患者手术治疗的同时进行椎体间微粒骨打压植骨融合.观察手术前后的症状、体征、影像学上的腰椎前凸角、椎间隙高度指数的变化,以及手术后CT检查椎体间植骨面积,同时随访6～26个月观察初期临床疗效和融合率.结果几乎所有患者手术后原症状和体征均得到缓解,影像学上的腰椎前凸角、椎间隙高度指数都有明显恢复,手术后6～26个月,脊柱融合率达到96.4%.没有发生植入骨的吸收、移位和沉陷.并发症主要为术中硬脊膜撕裂、神经根牵拉以及出血多等.结论后路减压、固定、椎体间微粒骨打压植骨融合治疗老年人腰椎退变性疾病早期临床疗效满意.

Objective To investigate the surgical technique of particle bone graft and impaction on posterior interbody fusion for senile lumbar degeneration and its initial clinical outcomes. Methods Twenty-eight cases of senile lumbar degeneration aged over 60 years were treated surgically with particle bone graft and impaction on posterior interbody fusion from May 2002 to August 2004. All the cases were observed on symptoms, signs and the changes of lumbar lordotic angle and intervertebral space height on radiology before and after operation,and the area of interbody graft was measured by postoperative CT. A follow-up period was lasted for 6-26 months to observe initial clinical effect and fusion rate. Results Almost all the cases obtained a good clinical effect after the operation. The symptoms and signs were both relieved. Lumbar lordotic angle and intervertebral space height on radiology were restored obviously. Spinal fusion rate achieved 96.4% after the follow-up. No implant was absorbed, shifted and sunk in all cases. Most complications were dura avulsion, nerve root drawn and more bleeding at surgery. Conclusion Initial clinical outcomes of posterior decompression, fixation, particle bone graft and impaction on posterior interbody fusion for senile lumbar degeneration are satisfactory.