单枚与双枚椎间融合器治疗退变性腰椎失稳症的临床对照研究

Clinical control study in treating degenerative lumbar instability with single or double carbon fiber cages

目的:探讨椎弓根螺钉系统加单枚碳纤维椎间融合器和椎弓根螺钉系统加双枚碳纤维椎间融合器在治疗退变性腰椎失稳症中的临床疗效及影像学差异。方法:回顾性分析自2005年11月至2006年10月收治且获得2年以上随访的退变性腰椎失稳症患者97例。所有患者均采用后路椎弓根螺钉系统固定,根据椎间融合方法不同,分为A组(单枚碳纤维椎间融合)和B组(双枚碳纤维椎间融合)。A组41例,男23例,女18例,年龄35～70岁,单节段不稳38例,L4,5、L5S1两节段椎间失稳3例。B组56例,男32例,女24例,年龄33～72岁,单节段不稳53例,L4,5、L5S1两节段椎间失稳3例。对两组病例的临床疗效、植骨融合率和椎间隙高度丢失等方面进行比较。结果:两组患者均获随访,时间24～35个月,平均28个月。按照JOA下腰痛29分法评定标准(包括症状、体征、日常生活动作和膀胱功能等方面)评估临床疗效,A组由术前平均(10.11±2.40)分上升到最后一次随访的平均(24.88±2.30)分,其中优25例,良12例,中4例;B组由术前平均(9.62±2.60)分上升到最后一次随访的平均(25.19±2.40)分,其中优37例,良13例,中6例。A组39例获得融合,融合率为95.1%(39/41),B组53例获得融合,融合率94.6%(53/56)。术后7d平均椎间高度A组为(11.2±1.2)mm,B组为(11.3±1.4)mm,术后2年A组为(11.0±1.4)mm,B组为(11.1±1.4)mm。经组间比较,两组在临床疗效、植骨融合率及椎间高度丢失方面均无统计学差异(P>0.05)。结论:在椎弓根螺钉系统固定的基础上,采用单枚或双枚碳纤维椎间融合器治疗退变性腰椎失稳症均能获得满意的临床疗效,植骨融合率高,且椎间隙高度维持良好。而单枚碳纤维椎间融合器相对双枚具有创伤小、操作简单、保留后柱结构、价廉等优点。

Objective：To compare the clinical and radiologic effect in treating degenerative lumbar instability with single or double carbon fiber cages. Methods：From November 2005 to October 2006,97 patients of degenerative lumbar instability were followed up more than two years. All cases underwent pedicle screw fixation. Meanwhile,41 of them,named group A,were applied with single carbon fiber cage,with 23 males and 18 females,aged for 35-70 years,including 38 cases with single vertebral instability and 3 cases with existing L4,5 and L5S1 intervertebral instability. The other 56 cases,named group B,were treated with two carbon fiber cages,with 32 males and 24 females,aged for 33-72 years,including 53 cases with single vertebral instability and 3 cases existing L4,5 and L5S1 intervertebral instability. The clinical effect,intervertebral fusion ratio and lost intervertebral height were compared between two groups. Results：All patients were followed up for 24-35 months,with an average of 28 months. Clinical effects （including symptom,sign,daily action and bladder function） were evaluated according to JOA 29 score. In group A：the JOA score improve from 10.11±2.40 preoperative to 24.88±2.30 at final follow up,25 cases obtained excellent results,12 good,4 fair;39 cases obtained fusion with the fusion ratio of 95.1%（39 / 41）. In group B：the JOA score from 9.62±2.60 preoperative to 25.19±2.40 at final follow up,37 cases obtained excellent results,13 good,6 fair; 53 cases obtained fusion with the fusion ratio of 94.6%（53 / 56）.In the 7th day after operation,the average intervertebral height in group A was （11.2±1.2） mm,and that of group B was （11.3±1.4） mm. Two years later,the average intervertebral height in group A was（11.0±1.4）mm,while that of group B was（11.1±1.4） mm. There was no significant difference between two groups in clinical effect,intervertebral fusion ratio and lost intervertebral height（P0.05）. Conclusion：Pedicle screw fixation and single or double carbon fiber cages in treating degenerative lumbar instability both can obtain satisfactory curative effect. Singlecarbon fiber cage has advantages such as minimally trauma,simply operation,retentively posterior column structure,cheaply price than double carbon fiber cages