三种椎间植骨材料治疗腰椎滑脱的比较研究

COMPARATIVE STUDY OF LUMBAR SPONDYLOLISTHESIS TREATED BY THREE DIFFERENT MATERIALS

目的比较采用自体髂骨、自体骨椎间融合器和骨形成蛋白(bone morphogenetic protein,BMP)人工骨椎间融合器椎间融合治疗成人腰椎滑脱的效果。方法1997年1月~2004年1月,收治114例腰椎滑脱患者。男45例,女69例;年龄32~61岁,平均43岁。其中度滑脱85例,度滑脱24例,度滑脱5例。患者均行椎弓根螺钉固定、后路椎间融合术,根据椎间融合材料的不同,将患者分为A组(自体髂骨椎间融合,42例);B组(自体骨/单枚椎间融合器,36例);C组(BMP人工骨/单枚椎间融合器,36例)。比较术后三组患者的手术时间、术中出血量、临床疗效、融合率和手术节段椎间隙高度的变化。结果术后患者均获随访13~30个月,平均15个月。三组手术时间、术中出血量及术前椎间隙高度比较,差异无统计学意义(P>0.05)。最后随访时,A、B及C组临床疗效评估优良率分别为81.0%、80.6%及83.3%,差异无统计学意义(P>0.05);术后1年,椎间融合率分别为81.0%、83.3%及97.0%,A、B组与C组间差异有统计学意义(P<0.05);椎间隙高度丢失A组与B、C组间差异有统计学意义(P<0.05)。结论BMP人工骨椎间融合器作为腰椎滑脱后路椎间融合的植骨材料,术后融合率高,椎间隙高度丢失少,临床疗效好,优于自体髂骨和自体骨椎间融合器。

Objective To evluate the clinical outcome of autografts of ilium and interbody fusion cage or bone morphogenetic protein （BMP）/artificial bone material/ cage in treating lumbar spondylolisthesis. Methods From January 1997 to January 2004,114 patients with lumbar spondylolisthesis were treated with posterior lumbar interbody fusion and pedicle screw fixation. There were 45 males and 69 females with an average age of 43 years ranging from 32 to 61 years. Of 114 patients, 85 cases were classified as degree Ⅰ , 24 cases as degree 1 and 5 cases as degree Ⅲ. The patients were divided into three groups according to the material used for interbody fusion： autografts of ilium （group A, n= 42）, interbody fusion cages （group B, n = 36）, and BMP/artificial bone material/ cage （group C, n = 36）. The clinical and radiographic results of the patients were compared among three groups. Results All patients were followed from 13 to 30 months with an average of 15 months. There were no statistically significant differences in surgical time, blood loss, and disc space height of pre-operation（P^0.05） among three groups. No severe complication occurred in the three groups（P〉0.05）. The excellent and good rates in groups A,B and C were 81.0%, 80.6%, and 83. 3 % respectively, showing no statistically significant difference （P〉0.05）. The fusion rate of group C （97.0 % ） was significantly higher than those of group A（81.0% ） and group B（83.30/00 ） （P〈0.05） after 1 year of operation. And the average loss of disc space height in groups B and C was significantly lower than that in group A（P〈0.05）. Conclusion Higher fusion rate and lower loss of disc space height can be obtained in treating lumbar spondylolisthesis with BMP/ artificial bone materiel. It is an effective method in the treatment of spondylolisthesis.