后路椎间打压植骨融合与聚醚醚酮植骨融合治疗腰椎不稳的临床研究

Instability of lower lumbar treated with posterior lumbar interbody fusion impacted bone graft or interbody fusion peek:clinical study

目的:通过对后路腰椎椎间融合椎弓根螺钉系统内固定术后进行随访。比较分析腰椎后路椎间打压植骨融合与聚醚醚酮(polyether ether ketone,PEEK)植骨融合加椎弓根螺钉系统在腰椎不稳治疗上的疗效分析。方法:收集我院2010年1月至2012年12月因腰椎不稳症行后路腰椎椎间融合术36例,男性20例,女性16例,年龄38～79岁,平均54.2岁。随机分A、B两组,两组术前、术后随访按日本矫形外科学会(JOA)评分,对术后临床症状缓解率、椎间隙高度、植骨融合率、椎体活动度、椎体矢状面移位进行比较。结果:①两组在术前、术后临床缓解率、椎体活动度、椎体矢状面移位差异有统计学意义(P<0.01),但两组之间比较差异无统计学意义(P>0.05)。②两组在术后植骨融合率比较差异无统计学意义(P>0.05)。③两组术前、术后及两组之间在椎间隙高度方面比较差异有统计学意义(P<0.01),PEEK组椎间隙高度从术前(5.79±1.48)mm到术后随访(11.18±0.78)mm,植骨组椎间隙高度从术前(5.84±1.54)mm到术后随访(9.90±0.88)mm,植骨组术后椎间隙高度丢失较多。结论:两种方式均能有效的治疗腰椎不稳,在临床症状缓解率、椎体矢状面移位、椎体活动度、椎体融合率等方面比较差异无统计学意义。PEEK同自体骨作为腰椎不稳椎间融合植骨材料,PEEK术后很好地恢复椎间隙高度,但费用贵。自体骨术后椎间隙高度丢失多,但无免疫排斥,费用便宜。无论我们选择采用自体骨或者PEEK,都尽可能提高植骨量,都要选择合适内固定。

Objective： Make the follow-up appointments of posterior lumbar interbody fusion with pedicle screw system fixation. Compare and analyze the clinical result of lumbar instability with posterior lumbar interbody impaetion grafting fusion, peek implanted bone fusion and pedicle screw system. Methods： From January 2010 to December 2012, 36 patients with lumbar instability were trea- ted with posterior lumbar interbody fusion, including 20 males and 16 females. The ages were from 38 to 79 with an average of 54.2 years old. They were divided into two groups randomly： group A and group B. Before and after the operation, the appointments of the two groups are scored according to the Japanese Orthopaedic Association （JOA）. The recovery rate, disc space height, bone fusion rate, vertebral activity, vertebral sagittal plane displacement are compared. Results： ①Before and after the operation, the differences in the recovery rate, vertebral activity rate and vertebral sagittal plane displacement were significant （P 〈 0.01 ）. But the differences between the two groups showed no statistical significance （P 〉 0.05 ）. ②The differences between the two groups of postoperative im- planted bone fusion rate showed no statistical significance （ P 〉 0.05 ）. ③The comparisons before and after the surgery of the two groups, and between the two groups in the intervertebral space height were significantly different （P 〈 0.01 ） ： the preoperative discheight of peek group changed from （5.79 ± 1.48） mm to a postoperative follow-up （ 1l. 18 ± 0.78） mm; the preoperative disc height of bone grafting group changed from （5.84 ± 1.54） mm to a postoperative follow-up （9.90± 0.88） ram. The bone grafting group loses more than the other. Conclusion： The two methods were effective in the treatment of lumbar instability. The comparison in clinical recovery rate, vertebral sagittal plane displacement, vertebral activity and vertebral fusion rate showed no statistical signifi- cance. The peek and autogenous bone can be used as the implanted bone material for lumbar instability interbody fusion. The peek helps better restore disc height after the surgery, but the cost is expensive. The autogenous bone loses more disc height without immune rejection and it is cheap. No matter which one we choose, autogenous bone or the peek, we should improve implanted bone quantity and select the appropriate internal fixation.