改良式椎体间植骨融合术治疗腰椎滑脱症疗效分析

Effect analysis of modified lumbar interbody fusion for the treatment of lumbar spondylolisthesis

目的探讨改良式椎体间植骨融合(双侧Cage植骨辅以椎间隙前侧及Cage间隙T形植骨融合)手术治疗腰椎滑脱症的临床疗效。方法收集2009年7月至2011年5月郑州市骨科医院收治且获得6个月以上随访的腰椎滑脱症患者93例,均采用后路椎弓根螺钉系统固定。根据椎间融合方式的不同,分为单纯Cage植骨融合组(A组,43例)和改良式椎体间植骨融合组(B组,50例)。按照0～9分法评估临床疗效,依据X线片及CT检查结果评价植骨融合情况,比较两组患者在临床疗效、影像学结果等方面的差异。结果所有患者获得完整随访,随访时间6～12个月,平均随访时间10.9个月。A组优24例、良8例、可11例,优良率74%;B组优39例、良6例、可5例,优良率为90%。两组比较,差异有统计学意义(χ2=3.940,P=0.047)。影像学评估:A组末次随访植骨融合率为74%(32/43)、B组为92%(46/50),两组比较,差异有统计学意义(χ2=5.283,P=0.021)。两组均未见神经损伤、切口感染以及内固定松动、植骨块或cage移位等并发症发生。结论与单纯Cage植骨比较,改良式椎体间植骨融合术治疗腰椎滑脱症疗效确切,植骨融合成功率高。

Objective To investigate clinical effect of modified posterior lumbar interbody fusion （PLIF） （bilateral bone grafting into the Cage, and T-shape bone grafting into anterior lateral intervertebral space and Cage space） for the treatment of lumbar spondylolisthesis. Methods From July 2009 to May 2011, 93 patients were performed PLIF in Zhengzhou Orthopeadics Hospital. According to the different interbody fusion methods, they were divided into pure Cage group （A group, n = 43） and modified group （B group, n = 50）. The clinical effect was evaluated with 0-9 scoring method, and the fusion results were observed by X-ray and CT examination, then the differences of two groups were compared with each other. Results All patients were followed up from 6 to 12 months, with the average of 10.9 months. In A group, there were excellent in 24 cases, good in 8 cases, fair in 11 cases, with the excellent and good rate of 74%; In B group, there were excellent in 39 cases, good in 6 cases, fair in 5 cases, with the excellent and good rate of 90%. The difference between two groups was statistically significant （x^2 = 3.940, P = 0.047）. According to the radiological evaluation, fusion rate at the last follow-up was 74% in A group and 92% in B group respectively, there had statistical difference （x^2= 5.283, P = 0.021）. No nerve injury, infection, internal fixation loosening, bone block displacement or Cage displacement had happened in two groups. Conclusion Compared with pure Cage fusion, modified intervertebral interbody fusion can obtain certain effect and high fusion rate for the treatment of lumbar spondylolisthesis.