椎弓根钉置入内固定与两种不同椎间植骨融合治疗退行性下腰椎不稳:同一机构4年27例资料回顾

Pedicle screw fixation in combination with two different interbody fusions for treatment of degenerative lumbar instability:A retrospective analysis of 27 cases from a same agency in 4 years

背景：良好的骨性融合对于椎弓根钉置入内固定治疗脊柱获得长期的稳定性至关重要。腰椎融合的方式很多,从融合的效果来看,目前以椎体间植骨融合最为可靠。目的：对比椎弓根钉置入内固定治疗退行性下腰椎不稳时采用打压植骨椎间融合与椎间融合器植骨融合的临床效果及放射学结果评价。方法：27例退行性下腰椎不稳症患者C臂机辅助透视下于定节段的椎弓根分别拧入椎弓根钉。按不同椎间植骨融合方法,将患者分为2组,16例打压植骨椎间融合,11例椎间融合器植骨融合。测量椎间隙高度后选用大小合宜的两个椎间融合器,把椎板及棘突骨块塞入融合器内腔并植入椎间隙。所有患者置入前、后均行X射线平片及CT检查。结果与结论：所有病例随访16~25个月,平均19个月。2组患者原有的腰背疼痛及神经症状明显改善：融合器组优良率为91.3%,自体骨组为89.4%,两组间差异无显著性意义。置入后1年融合器组的融合率为87.5%,自体骨组为90.9%,两组间差异无显著性意义;最终随访时椎间隙高度融合器组高于自体骨组,提示椎弓根钉内固定的组织相容性良好,配合自体骨打压植骨治疗后椎间隙高度虽有一定程度丢失,但融合率和临床优良率与置入椎间植骨融合器差异无显著性意义。

BACKGROUND：Good bone fusion is essential for spinal long-term stability.There are many methods of bone fusion.According to the results of some retrospective studiess,interbody fusion is the most reliable way.OBJECTIVE：To investigate the clinical and imaging outcome for the treatment of degenerative lumbar instability with posterior pedicle screw fixation plus carbon fiber cage interbody placement or bone graft interbody placement.METHODS：A total of 27 patients with degenerative lumbar instability were treated with pedicle screw fixation.All patients were randomized to carbon fiber cage interbody placement（CFCIP） group（n=16） and to bone graft interbody placement（BGIP） group（n=11）.Two appropriate fusion cages were used following measurement of intervertebral space height,and the vertebral plate andspinouse process blocks were filled in the cage and implaned into the intervertebral space.The fusion status and interbody heightwere reviewed under radiographic documents and CT.RESULTS AND CONCLUSION：All patients were followed up for an average of 19 months（range,16 to 25 months）.The neurologic function and back pain improved significantly in two groups.The excellent and good rate was 91.3% in CFCIP group obtained and 89.4% in BGIP group.The fusion rate was 87.5% in CFCIP group,and 90.9% in BGIP group one year after operationThe average intervertebral height of CFCIP group was greater than BGIP group at the end of follow-up.Results show that the pedicle screw fixation displayed good histocompatibility and the average intervertebral height tends to be less following CFCIP compared with BGIP,but the fusion rate and clinical excellent and good rate were no different significantly.