经椎间孔腰椎体间融合术中应用单枚融合器和自体骨移植骨融合的疗效分析

The efficacy analysis for the treatment with one cage and excised local bone graft in transforaminal lumbar interbody fusion

目的研究单枚融合器及手术局部自体骨移植行经椎间孔腰椎体间融合术（TLIF）的影像学结果以及临床疗效。方法 76例患者共融合82个节段行TLIF手术。影像学评价包括植骨面积百分比、融合率、椎间盘后高（PH）和腰椎运动节段前凸角（LA）;临床疗效评价包括改良Prolo功能评分、疼痛视觉类比评分（VAS）。结果患者均获随访,时间12~32个月。术后腰椎运动节段椎间盘PH、腰椎LA均较术前明显恢复（tPH=2.577,PPH=0.024;tLA=2.249,PLA=0.021）;末次随访无明显丢失。植骨面积百分比为40%~75%（53.1%±15.3%）;其中融合器占15%~26%（20.4%±5.3%）。融合率达97.6%。根据改良Prolo功能评分：优39例,良32例,可5例,优良率为93.4%。术后VAS较术前降低（t=3.234,P=0.012）。结论应用单枚融合器行TLIF能有效地恢复和维持腰椎的力线与平衡,并提供足够的机械稳定,使绝大多数患者获得优良的临床疗效;手术局部自体骨植骨满足椎体间融合的要求,并避免取髂骨植骨。

Objective To investigate the imaging results and treatment outcomes of transforaminal lumbar interbody fusion（TLIF） with one cage and excised local bone graft.Methods 76 patients underwent TLIF with one cage and excised local bone graft were studied retrospectively,with a total of 82 levels were performed fusion.The imaging evaluation included ratio of interbody graft area,fusion rate,posterior disc height（PH） and lordosis angle（LA） of motion segment.The treatment outcomes included modified Prolo scale and visual analog scale（VAS）.Results All patients were followed-up with a duration of 12～32 months postoperatively.There were significant improvement of PH and LA postoperatively（tPH=2.577,PPH=0.024;tLA=2.249,PLA=0.021）,and no significant loss of PH and LA was found at the final follow-up.The interbody graft area was 40%~75%（53.1%±15.3%）,and the cage area was corresponded for 15%~26%（20.4%±5.3%）;the fusion rate of this series was 97.6%.According to the modified Prolo scale,93.4% of the patients obtained excellent or good result.（excellent：39 patients;good：32 patients;fair：5 patients）.The VAS significantly decreased postoperatively（t=3.234,P=0.012）.Conclusions TLIF with one cage can restore segmental alignment and balance,and provide excellent stability and stiffness to ensure satisfactory outcomes.Excised local bone graft can satisfy solid interbody fusion without harvesting and grafting the autologous iliac bone.