椎弓根钉内固定系统结合Cage植骨治疗严重腰椎滑脱的临床效果评价

Effect Evaluation of Transpedicle Screw Internal Fixation System Combined with Cage Interbody Fusion in Severe Lumbar Spondylolisthesis

目的探讨椎弓根钉内固定系统结合Cage植骨治疗严重腰椎滑脱的临床疗效。方法选择2008年7月至2012年7月威海市立医院行后路椎弓根钉内固定治疗的严重腰椎滑脱患者62例为研究对象,采用投掷硬币法随机分为椎间植骨组(30例)和椎间Cage植骨组(32例)。两组均行腰椎滑脱后路椎弓根钉内固定手术,其中椎间植骨组加行后路椎间植骨融合手术,椎间Cage植骨组加行后路椎间Cage植骨融合手术,比较两组术后1年内Na Kai评分优良率、植骨融合率、椎间隙高度及腰骶角的变化。结果椎间Cage植骨组Na Kai评分优良率显著高于椎间植骨组(90.6%比66.7%,P<0.05);椎间Cage植骨组椎间融合率显著高于椎间植骨组(84.4%比60.0%,P<0.05);治疗后椎间Cage植骨组椎间隙高度高于椎间植骨组[(75.05±6.32)%比(67.94±6.13)%,P<0.01],腰骶角低于椎间植骨组[(36.52±3.51)°比(39.63±3.87)°,P<0.01]。结论与椎间植骨相比,椎弓根钉内固定系统结合Cage植骨治疗严重腰椎滑脱效果更为理想。

Objective To explore the effect of transpedicle screw fixation system combined with Cage interbody fusion in severe lumbar spondylolisthesis.Methods Total of 62 cases with severe lumbar spon-dylolisthesis underwent transpedicle screw fixation system treatment in Weihai Municipal Hospital from Jul . 2008 to Jul.2012 were selected as research subjects.According to coin toss method,they were divided into the intervertebral bone graft group of 30 cases,interbody fusion Cage group of 32 cases.Both groups under-went lumbar spondylolisthesis by posterior pedicle screw internal fixation operation,intervertebral bone graft group underwent posterior lumbar interbody fusion with bone grafting operation ,interbody fusion Cage group underwent posterior lumbar interbody Cage fusion operation.NaKai scale,the fusion rate,the change of disc height and lumbosacral angle of the two groups were compared.Results The excellent and good rate of NaKai scale in interbody fusion Cage group was higher than that in intervertebral bone graft group with signif-icant difference （90.6% vs 66.7%,P〈0.05）;the bone graft fusion rate of the intervertebral bone graft group and interbody fusion Cage group were 84.4%and 60.0%, with significant difference （P〈0.05）;the disc height and lumbosacral angle in interbody fusion Cage group were （75.05 ±6.32）% and （36.52 ± 3.51）°, which were higher than the intervertebral bone graft group′s[（67.94 ±6.13）% and （39.63 ± 3.87）°]（P〈0.01）.Conclusion Compared with intervertebral bone grafting,transpedicle screw fixation system combined with Cage interbody fusion for severe lumbar spondylolisthesis has better clinical effect .