两种改进的自体骨融合方式在后路腰椎融合术中的应用研究

Study of the clinical effects of two improved autogenous bone fusion methods

目的回顾研究两种改进的自体骨融合方案(自体颗粒骨打压植骨、自体骨cage植骨)与PEEK cage植骨在腰椎后路融合手术中的临床疗效差异,旨在证实其临床价值。方法收集2010年6月至2016年6月因退行性腰椎疾患在我科行腰椎融合术的患者,根据腰椎融合的采用情况将患者分为自体骨打压组36例、自体骨cage组35例、PEEK cage组39例。观察手术前后的VAS、ODI评分,并在影像学资料上计算术后24h、术后6月、术后12月的椎间隙高度丢失度及椎体融合率。术前患者一般资料无统计学差异,资料可比性良好。结果三组术后均未发生严重的手术相关并发症。影像学结果示术后6月、12月的椎体高度丢失度分别为:打压植骨组(6.1±2.5、6.5±3.8)%;自体骨cage组(5.6±2.9、5.8±3.7)%;PEEK cage组(5.4±3.3、5.9±4.1)%。术后6月、12月的椎间相对融合率为:打压植骨组(27.5±10.5、26.5±9.1)%;自体骨cage组(31.2±8.7、28.1±8.7)%;PEEK cage组(28.4±7.1、29.3±8.2)%。各组结果均无统计学差异(P>0.05)。术后三组的ODI、VAS评分亦无统计学差异(P>0.05)。结论三组术后的临床疗效及术后融合率无明显差异,自体颗粒骨打压植骨、自体骨cage植骨融合效果良好。

Objective To retrospectively study the clinical effect of two improved autologous bone lumber interbody fusion methods（autogenous bone interbody fusion cage（ABIF） and autogenous morselized bone graft impaction（AMBI）） compared with the PEEK cage fusion. Methods The clinical data of 110 cases of patients who took the lumber fusion surgery from 2010 to 2016 were collected. All the cases were divided into three groups by the fusion method： AMBI：36 cases, ABIF：35 cases, PEEK：39 cases. The VAS score, ODI score at the time point of pre-operation, 6 months post-operation and 12 months post-operation were evaluated, the loss of intervertebral space height on X-ray and the relative fusion rate on CT scanning at the time point of 24 h post-operation, 6 months post-operation and 12 months post-operation was evaluated.The general information of three groups had no statistical significance, indicating good comparability of the three groups. Result All three groups had no serious complications. The loss of intervertebral space height 6 m and 12 m post-operation of each group： AMBI：（6.1±2.5、6.5±3.8）% , ABIF：（5.6±2.9、5.8±3.7）% ;PEEK：（5.4±3.3、5.9 ± 4.1）% ,the relative fusion rate 6 months and 12 months post-operation of each group： AMBI：（27.5 ±10.5、26.5±9.1）% , ABIF：（31.2±8.7、28.1±8.7）% , PEEK：（28.4±7.1、29.3±8.2）% .Statistical results showed VAS score, ODI score, loss of intervertebral space height and the relative fusion rate 6 m and 12 m post-operation of each group have no statistical significance（P〈0.05）. Conclusion All three groups have the same clinical effect and fusion rate, the result indicate a good promise of clinical application of AMBI and ABIF.