不同后路椎间融合方案在腰椎退行性疾病患者中的应用

Comparison on the effect of different posterior lumbar interbody fusion in patients with lumbar degenerative diseases

目的比较三种不同后路椎间融合方案治疗腰椎退行性疾病的疗效。方法回顾性分析2014年4月至2015年4月于眉山市人民医院骨科行后路腰椎椎体间融合术的82例腰椎退行性疾病患者的临床资料,根据手术方案不同分为A组(22例)、B组(26例)和C组(34例),分别采用单纯椎体间植骨、单枚椎间融合器(Cage)或双枚Cage结合椎体间植骨三种不同后路椎间融合术治疗。术后门诊随访1年。统计各组患者术中出血量、手术时间、住院天数及并发症发生率,术后3 d采用视觉疼痛量表(VAS)评价患者疼痛情况、植骨融合情况、Oswestur功能障碍指数(ODI)评分和疗效。结果 C组患者手术时间、术中出血量和术后3 d VAS疼痛评分均明显高于A组和B组,差异有统计学意义(P<0.05),而A组和B组各项指标比较差异均无统计学意义(P>0.05);术前、术后6个月和术后12个月,三组患者的ODI评分比较差异均无统计学意义(P>0.05);三组患者的融合率、JOA评分改善率和并发症发生率比较差异也均无统计学意义(P>0.05)。结论单纯椎体间植骨和Cage结合椎体间植骨后路椎间融合术治疗腰椎退行性疾病均具有良好的效果,应该对症选择治疗方案。与双Cage相比,单Cage方案具有手术时间短、出血量少的特点,而二者疗效相当,后路腰椎椎体间融合术单Cage是一种更好的选择。

Objective To compare the efficacy of single interbody bone graft, single Cage combined with inter- body bone graft, and double Cage combined with interbody bone graft in the treatment of lumbar degenerative diseases. Methods Eighty-two patients with lumbar degenerative disease who underwent posterior lumbar interbody fusion in our hospital from April, 2014 to April, 2015 were selected. The patients were divided into group A （n=22）, group B （n= 26） and group C （n=34）, which were treated with single interbody bone graft, single Cage combined with interbody bone graft, and double Cage combined with interbody bone graft, respectively. All patients were followed up for 1 year. The blood loss, operation time, length of hospital stay, complication rate, visual analogue scale （VAS） at 3 days after opera- tion, bone graft fusion, Oswestur disability index （ODI） score, and efficacy were evaluated. Results The operation time, intraoperative blood loss and VAS score in group C were significantly higher than those in group A and B （P〈 0.05）, and the indexes showed no significant difference between group A and group B （P〉0.05）. There was no significant difference in ODI scores among the three groups before operation, 6 or 12 months after operation （P〉0.05）, and there was also no significant difference in the fusion rate, improvement rate of JOA scores, and incidence of complications among the three groups （P〉0.05）. Conclusion Posterior lumbar interbody fusion with single interbody bone graft or complicated with Cage showed relative high effect in the treatment of degenerative lumbar degenerative diseases. Com- pared with the double Cage, single Cage brings less operation time, less bleeding, and similar efficacy, which puts single Cage combined with interbody bone graft a better choice.