聚醚醚酮椎间融合器与自体髂骨在经椎间孔椎体间融合术治疗腰椎间盘突出症中的应用价值

Application value of PEEK interbody fusion device and autogenous iliac bone in TLIF treatment of lumbar disc herniation

目的 比较聚醚醚酮(polyether-ether-ketone, PEEK)椎间融合器与自体髂骨在经椎间孔椎体间融合术(transforaminal interbody fusion, TLIF)治疗腰椎间盘突出症中的应用价值。方法 选取行TLIF的腰椎间盘突出症患者70例为研究对象,采用随机数字表法将患者分为2组,观察组35例采用自体髂骨治疗,对照组35例采用PEEK椎间融合器治疗。观察2组术中出血量、手术时间、住院时间、并发症发生率,比较2组术前及术后不同时间点的视觉模拟疼痛(visual analogue scale, VAS)评分、Oswestry功能障碍指数(Oswestry disability index, ODI)及椎间隙高度情况,比较2组术后植骨融合率。结果 观察组术中出血量、手术时间明显高于对照组(P<0.05),2组住院时间及并发症发生率比较差异无统计学意义(P>0.05)。2组VAS评分均随着术前术后时间的推移一直降低,时点间比较差异有统计学意义(P<0.05),但组间和组间·时点间交互作用比较差异无统计学意义(P>0.05),2组ODI评分随着术前术后时间的推移一直降低,时点间比较差异有统计学意义(P<0.05),但组间和组间·时点间交互作用比较差异无统计学意义(P>0.05)。2组术前椎间隙高度随着术前术后时间的推移先增大后减小,时点间比较差异有统计学意义(P<0.05),但组间和组间·时点间交互作用比较差异无统计学意义(P>0.05)。观察组术后3个月及术后6个月植骨融合率均高于对照组(P<0.05),术后12个月植骨融合率比较差异无统计学意义(P>0.05)。结论 在TLIF手术中使用自体髂骨与PEEK椎间融合器均能有效治疗腰椎间盘突出症,但自体髂骨治疗前期的融合率更具有优势。

Objective To compare the application value of polyether-ether-ketone(PEEK)interbody fusion device and autogenous iliac bone in the treatment of lumbar disc herniation by transforaminal lumbar interbody fusion(TLIF).Methods Seventy patients with lumbar disc herniation who underwent TLIF were selected as the research subjects.The patients were divided into two groups by random number table method.Thirty-five patients in the observation group were treated with autogenous iliac bone and 35 patients in the control group were treated with PEEK interbody fusion device.The intraoperative blood loss,duration of operation,duration of hospital stay and complication rate of the two groups were observed.The visual analogue scale(VAS)score,Oswestry disability index(ODI)and intervertebral space height of the two groups were compared before operation and at different time points after operation,and the fusion rate of bone graft after operation was compared between the two groups.Results The intraoperative blood loss and duration of operation in the observation group were significantly higher than those in the control group(P<0.05),and there was no significant difference in duration of hospital stay and incidence of complications between the two groups(P>0.05).The VAS scores of both groups decreased with the passage of time before and after operation,and there was a significant difference between different time points(P<0.05);however,there was no significant difference in the interaction between groups and time points(P>0.05).The ODI scores of the two groups decreased with the passage of time before and after operation,and the difference between time points was statistically significant(P<0.05).However,there was no significant difference in the interaction between groups and time points(P>0.05).The preoperative intervertebral space height of the two groups first increased and then decreased with the passage of time before and after operation,and the difference of interaction between time points was statistically significant(P<0.05);however,there was no significant difference in the interaction between groups and time points(P>0.05).The bone graft fusion rate in the observation group was higher than that in the control group at 3 months and 6 months after surgery(P<0.05),and there was no significant difference in the bone graft fusion rate at 12 months after surgery(P>0.05).Conclusion Both autogenous iliac bone and PEEK interbody fusion device can effectively treat lumbar disc herniation during TLIF surgery,but the fusion rate of autogenous iliac bone in the early stage of treatment is more advantageous.