两种不同椎间植骨融合术治疗腰椎不稳临床疗效分析

Comparision of Two Different Methods of Lumbar Interbody Fusion with Pedicle Screw Fixation for Lumbar Instability

目的比较两种不同椎间植骨融合术治疗腰椎不稳的临床疗效及各自优缺点。方法回顾性分析自2012年6月至2013年6月采用两种不同的植骨方法治疗64例腰椎不稳患者的临床资料,按照患者意愿分为打压植骨组和椎间融合器植骨组。打压植骨组40例,男28例,女12例;平均年龄62岁。椎间融合器植骨组24例,男16例,女8例;平均年龄61岁。观察并比较两组手术术后椎间隙高度变化、日本骨科协会（Japanese orthopaedic association,JOA）评分、临床疗效优良率及植骨融合率等指标。结果术后患者均获随访,随访时间16~28个月,平均23个月。两组术后及末次随访时椎间隙高度与术前相比均有显著提高,差异有统计学意义（P〈0.05）;与术后即刻比较,椎间融合器植骨组显著高于打压植骨组,差异有统计学意义（P〈0.05）。术前两组均行JOA评分比较,差异均无统计学意义（P〉0.05）。末次随访时,各组JOA评分均较术前显著降低。术后1年复查X线片显示：椎间融合器植骨组植骨融合率均显著高于打压植骨组。结论椎弓根钉内固定结合椎间打压植骨融合与椎间融合器植骨融合治疗腰椎不稳,两种术式比较无明显临床疗效差异,可根据患者的具体情况选择相应术式。

Objective To investigate the clinical efficacy of the two different methods of interbody fusion for lumbar insta-bility and to compare their respective advantages and disadvantages. Methods From June 2012 to June 2013,64 patients with lumbar instability underwent pedicle screw fixation using two different bone grafts. Of 64 patients,40 received bone graft impac-tion with lumbar interbody fusion,and 24 received interbody fusion cage. Postoperative intervertebral height changes,JOA score,clinical curative rate and fusion rate index were recorded and compared. Results All patients were followed up,the fol-low-up time ranged from 16 to 28months,average 23 months The intervertebral space heights were significantly improved in 2 groups at immediately after operation and last follow-up compared with those before operation（P 〈 0. 05）. Compared with the immediate postoperative,lumbar interbody fusion group was significantly less than the impaction bone grafting group,the differ-ence was statistically significant（P 〈 0. 05）. There was no significant difference in JOA score in two groups before operation. （P 〉 0. 05）. At the time of the last follow-up,both groups of JOA scores were decreased significantly. In one year after opera-tion,X-ray film showed that the fusion rate of the interbody fusion cage group was significantly higher than that of the impaction bone grafting group. Conclusion There is no significant difference in the clinical efficacy between bone graft impaction and bone graft impaction in the treatment of lumbar with pedicle screw fixation. In order to obtain better treatment effect,it is neces-sary to select appropriate method according to the specific condition of patients.