后路椎体间打压植骨融合治疗腰椎失稳的临床观察

Clinical observation of bone graft and impaction on posterior interbody fusion for lumbar instability

目的:探讨后路椎体间打压植骨融合术治疗腰椎失稳症的临床疗效和适应证。方法:分析2001年1月至2008年7月95例腰椎失稳行后路椎体间打压植骨融合术的患者,其中男41例,女54例;年龄45～76岁,平均59岁。其中单节段68例,2节段22例,3节段5例,共127个椎间隙。术中椎管及患侧神经根彻底减压,由患侧切除椎间盘组织,大范围刮除软骨板直至终板,使用切除的椎板等骨质打压植骨,配合椎弓根螺钉内固定。观察手术前后的症状体征并进行JOA评分;通过腰椎X线片测量手术前后椎间高度变化并根据SUK方法观察植骨融合情况。结果:95例患者均获得随访,时间12～90个月,平均44.8个月。术后临床症状明显缓解或消失,127个椎间隙均获融合,未发生植入骨移位及严重并发症。影像学示术后椎间高度较术前显著增加。术后8周JOA评分为(25.1±2.8)分,最终随访时(24.8±3.2)分,与术前(11.3±3.3)分相比,差异有统计学意义(P<0.001)。结论:后路椎体间打压植骨融合术可作为治疗腰椎失稳的有效方法之一,适用范围广,尤其适用于老年腰椎退变性不稳。

Objective：To investigate the clinical effect and indication of bone graft and impaction on posterior interbody fusion for lumbar instability. Methods：From January 2001 to July 2008,95 patients with lumbar instability were treated by bone graft and impaction on posterior interbody fusion. Including 41 males and 54 females,the age from 45 to76 years old with an average of 59 years. There were 68 cases with single level,22 cases with two level,5 cases with three level in patients, which were 127 intervertebral space altogether. The neural canal and affected side nerve root were decompressed thoroughly during operation. Resected the disc from the affected side and erased the cartilage to plate extensively combined with pedicle screw fixation,and impaction on interbody fusion with the excisional vertebral plate bone was achieved. To assess the improvement of the patients＇ symptom,sign,and JOA scores pre and post operatively. Meanwhile,the changes of intervertebral height from the lumbar radiographs were measured and the degrees of interbody bone fusion were evaluated according to SUK method. Results：All the 95 patients were followed up from 12 to 90 months with the mean of 44.8 months. All the clinical symptom were improved significantly or disappeared completely. All the 127 intervertebral space achieved good bone fusion. There was no displacement of bone graft and severe complication happened. According to the radiograph,all the intervertebral heights were increased obviously. The mean JOA score improved from 11.3±3.3 preoperative to 25.1±2.8 at 8 weeks postoperative; achieved 24.8±3.2 with followed up at the last time （P0.001）. Conclusion：Bone graft and impaction on posterior interbody fusion was one of the most effective methods for the lumbar instability. It has extensive range of application,and it＇s suitable for senile lumbar degeneration instability especially.