三种不同植骨方法在TLIF手术治疗腰椎退变性疾病的临床研究

Clinical Study of Three Different Bone Grafting Methods in the Treatment of Lumbar Degenerative Diseases with TLIF

目的:探讨三种不同植骨方法在经椎间孔椎间融合(TLIF)手术治疗腰椎退变性疾病的临床疗效。方法:回顾性分析2012年1月至2016年1月间于广州军区广州总医院接受TLIF手术治疗109例腰椎退变性疾病患者的临床资料,根据融合方式分为自体髂骨+融合器(A组,42例)、自体椎板关节突骨+融合器(B组,38例)、同种异体骨+融合器(C组,29例)。术后随访3个月、6个月、12个月,比较三组患者手术相关指标、术后椎间融合率、疼痛VAS评分、腰椎JOA评分等情况。结果:三组患者的手术时长、术中出血量、住院时间等手术相关指标比较,均无统计学差异(P>0.05)。术后3个月,A组椎间融合率均高于B组、C组,均具有统计学差异(P<0.05),术后6、12个月融合率无统计学差异(P>0.05)。术前,三组患者的VAS、JOA评分比较,无统计学差异(P均>0.05)。术后3、6、12个月,三组患者的VAS评分均低于术前,术后3个月3组间比较有统计学差异,术后6、12个月比较无统计学差异(P均>0.05);术后3、6、12个月,三组患者的JOA评分均高于术前,组间比较无统计学差异(P均>0.05),组内两两比较均具有统计学差异(P均<0.05)。结论:三种不同植骨方法TLIF手术治疗腰椎退变性疾病是有效的手术方式,三者近期疗效满意,术后3个月自体髂骨融合组的椎间融合率优于自体椎板关节突骨融合、同种异体骨融合组。

Objective:To explore the clinical effect of three different bone grafting methods in the treatment of lumbar degenerative diseases by TLIF.Methods:The clinical data of 109 patients with lumbar degenerative diseases who were treated by TLIF in Guangzhou General Hospital of Guangzhou Military Region from January 2012 to January 2016 were analyzed retrospectively.According to the fusion mode,they were divided into autoiliac bone+fusion cage(group A,42 cases),autolaminar articular process bone+fusion cage(group B,38 cases),allogeneic bone+fusion cage(Group C,29 cases).The patients were followed up for 3 months,6 months and 12 months.The operative indexes,fusion rate,VAS score of pain and JOA score of lumbar vertebrae were compared among the three groups.Results:There was no significant difference in operation time,intraoperative blood loss and hospital stay among the three groups(P>0.05).Three months after operation,the fusion rate of group A was higher than that of group B and group C,with statistical difference(P<0.05).There was no statistical difference in the fusion rate of 6 and 12 months after operation(P>0.05).Before operation,there was no significant difference in VAS and JOA scores among the three groups(P>0.05).At 3,6 and 12 months after operation,the VAS scores of the three groups were lower than that before operation,and there was statistical difference between the three groups at 3 months after operation,but there was no statistical difference between the three groups at 6 and 12 months after operation(P>0.05);at 3,6 and 12 months after operation,the JOA scores of the three groups were higher than that before operation,and there was no statistical difference between the three groups(P>0.05),and there was statistical difference between the two groups(P<0.05).Conclusion:TLIF is an effective method for the treatment of lumbar degenerative diseases.The short-term effect of the three methods is satisfactory.The interbody fusion rate of the autogenous ilium fusion group is better than that of the autogenous laminectomy fusion group and the allogeneic bone fusion group 3 months after the operation.