自体颗粒骨打压植骨腰椎椎体间融合术治疗下腰椎退变性不稳的疗效

Efficacy of pedicle screw fixation and lumbar interbody fusion with autogenous morselized bone graft impaction in treatment of degenerated lumbar instability

目的：探讨后路自体颗粒骨打压植骨腰椎椎体间融合内固定术治疗下腰椎退变性不稳的临床疗效。方法：回顾性分析2007年12月至2009年6月确诊为下腰椎退变性不稳并神经根管狭窄行后路自体颗粒骨打压植骨腰椎椎体间融合内固定术治疗患者16例。观察临床疗效及椎体融合情况。结果：所有患者原有神经压迫症状大部分恢复，术后VAS评分较术前改善，（P〈0．05）。椎间高度由术前平均高度（5．12±0．98）mm增加到术后平均（12．71±1．00）mm（P〈0．05），4～5个月后可见骨融合征象，椎间融合率约为水93．8％（15／16）。内固定未见松脱、断裂等并发症，优良率87．5％（14／16）。结论：后路自体颗粒骨打压植骨腰椎椎体间融合内固定术可达到彻底减压、神经根松解、腰椎稳定性的重建、满意植骨合率的目的，同时具有医疗费用低、并发症少的优点，是治疗下腰椎退变性不稳的有效方法之一。

Objective：To investigate the clinical efficacy of pedicle screw fixation and posterior lumbar interbody fusion （PLIF） with antogenous morselized bone graft impaction in treatment of degenerated lumbar instability. Methods： Between December 2007 and June 2009, sixteen patients diagnosed as having degenerated lumbar instability and foraminal stenosis, and scheduled for pedicle screw fixation and PLIF with autogenous morselized bone graft impaction, were reviewed for the clinical efficacy of surgery and outcomes of fusion. Results ： Most of nerve compression symptoms resolved among all patients, and the VAS score was improved after surgery compared with baseline （ P 〈 0.05 ）. The mean interbody height was increased from preoperative （5.12±0. 98） mm to postoperative （ 12.71±1.00） mm （ P 〈 0.05 ）. Bone fusion could be seen after 4～5 months, with interbody fusion rate being 93. 8%. The internal fixasion was not complicated with loosening or rupture. Favorable outcome was noted in 87.5% of the patients. Conclusion： Pedicle screw fixation and PLIF with autogenous morselized bone graft impaction may well contribute to decompression, nerve root neurolysis, restoration of lumbar stability and satisfactory bone fusion. Less medical expense and complications with this treatment further support its effective use in degenerated lumbar instability.