椎管减压自体颗粒骨在腰椎间融合术中的应用

Appplication of local autogenous bone chips in the lumbar interbody fusion

目的 评价椎管减压所得自体颗粒骨在腰椎间融合术中的临床应用价值.方法 回顾性分析2008年10月至2012年10月间143例接受腰椎椎管减压、应用椎管减压所得自体颗粒骨行椎间植骨融合术的腰椎病变患者的临床资料.运用日本骨科协会评估治疗分数（JOA）和视觉模拟评分法（VAS）评估患者术前术后腰腿疼痛情况;采用Oswestry功能障碍指数（ODI）标准进行术后疗效评定;同时采用Jorgenson 标准评价术后腰椎融合节段的融合情况.结果 术后143 例均获随访,随访时间12.0～30.0个月,平均15.6 个月.术后切口有1例出现脂肪液化,1例伤口皮下积液,其余均Ⅰ期愈合,未发生切口红肿、渗出、感染.VAS评分：术前（7.63＆#177;1.52）分,末次随访 （2.17＆#177;1.09）分;JOA 评分：术前（11.36＆#177;4.67）分,末次随访 （24.87＆#177;2.23）分;ODI指数评价：术前（79.8＆#177;10.8）%,末次随访（17.6＆#177;6.4）%.以上三指标随访期间与术前比较差异均有统计学意义（P＜0.01）.术后1年X 线片示脊柱融合135例,8例未融合,融合率为88.6%,平均融合时间为5.8个月.结论 椎管减压颗粒骨椎间植骨在腰椎间融合术中可获得良好术后疗效和融合率,而且费用低,操作简单.

Objective To evaluate the clinical effect and value of local autogenous bone chips in the lumbar interbody fusion. Methods From October 2008 to October 2012, 143 cases which underwent lumbar fusion with local autograft bone from spinal canal decompression were analyzed retrospectively. The preoperative and postop- erative pain of the low back and leg was evaluated by visual analog scale （VAS） and Japanese Orthopaedic Associa- tion Scores （JOA）. The postoperative efficacy was assessed by Oswestry disability index （ODD. The fusion rate was defined by Jorgenson fusion criteria. Results All cases were followed up for 12-30 months with an average of 15.6 months. The postoperative wound healed by hrst intention, and no red swelling, exudation and in%ction oc- curred, except fat liquefaction in 1case and subcutaneous hydrops in 1 ease; The VAS score before operation was （7. 63 ± 1.52）, and that at the final follow-up was （2. 17 ± 1.09）. The JOA score before operation was （11.36 ± 4. 67） and that at the final follow-up was （24. 87 ± 2. 23）. The ODI score before operation was （79. 8 ± 10. 8）%, and that at the final follow-up was （17. 6 ± 6.4）%. For all 143 cases, JOA, VAS and ODI scores at the final fol- low-up were significantly lower than those preoperation （P〈0. 01）. The postoperative X-ray fusion rate within 1 year was 88. 6%, including 135 cases of lumbar interbody fusion and 8 eases of non-fusion, and the average time of fusion was 5.8 months. Conclusion The local autograft hone from spinal canal decompression can achieve good ef- ficacy and high fusion rate in lumbar interbody fusion.