两种Cage植骨治疗腰椎不稳症的临床疗效观察

发布时间：2018-04-13 08:31

本文选题：腰椎不稳症 + Cage　；参考：《成都中医药大学》2015年硕士论文

【摘要】：目的：通过观察经后路行单纯Cage植骨融合术结合椎弓根内固定与椎间隙Cage前方打压植骨融合术结合椎弓根内固定治疗腰椎不稳症的临床疗效,分析这两种植骨方式在椎体融合临床疗效中的有效性、稳定性等,为临床提供参考依据。方法：通过观察成都中医药大学附属医院骨科及成都市第二人民医院骨外科2013年3月至2014年3月期间腰椎不稳症经后路行椎弓根内固定结合Cage植骨融合术并获得完整随访资料的病例60例。随访时间为12个月。A组30例患者采用单纯Cage植骨融合术结合椎弓根内固定术;B组30例患者采用椎间隙Cage前方打压植骨结合椎弓根内固定术。两组分别于术前至术后1、3、6、12个月监测如下指标：术中植骨时间、椎间隙高度、椎体间活动角、日本骨科学会(JOA)腰背痛手术评分、Oswestry功能障碍指数、融合率等。统计数据应用SPSS20.0软件分析。结果：两种Cage植骨方式结合椎弓根内固定系统治疗腰椎不稳症效果明显,两组手术治疗术后的椎间隙高度、椎间活动域、JOA评分、Oswestry功能障碍指数等方面均较术前有了显著改善(P0.05)。说明两组手术对于治疗腰椎不稳症的症状的疗效是确切的。又单从两组的融合率来看,两组植骨方式对于腰椎融合的成功率无统计学显著差异(P0.05),说明两组手术治疗在融合率方面无区别。但是两组在术后的单个观察指标之间还是存在差异的。在术后维持椎间隙高度方面,椎间隙Cage前方打压植骨明显高于单纯Cage植骨组(P0.05)；而在术中的植骨时间方面,A组明显少于椎间隙Cage前方打压植骨组。结论：两种Cage植骨方式结合椎弓根内固定系统治疗腰椎不稳症效果均明显,虽然两组试验对于融合率并无显著差异,但是两种Cage植骨融合术同样存在差异。(1)椎间隙Cage前方打压植骨组能更有效的维持椎间隙高度；(2)椎间隙Cage前方打压植骨组因增加了植骨量,同时扩大了与上下终板下骨的接触面积能更有利于融合；(3)单纯Cage植骨融合组在节约手术时间方面更具优势。
[Abstract]:Objective: To observe the posterior with Cage interbody fusion combined with pedicle screw fixation and interbody fusion Cage front impaction bone grafting combined with the clinical curative effect of pedicle screw fixation in treatment of lumbar instability syndrome, analysis of the two bone fusion effectiveness, clinical efficacy in vertebral stability, provide a reference basis for clinical methods. Through the observation of the Department of orthopedics in the Affiliated Hospital of Chengdu University of Traditional Chinese Medicine and Chengdu City Second People's Hospital of bone surgery from March 2013 to March 2014 during the period of lumbar instability with posterior pedicle screw fixation combined with interbody fusion in 60 cases of Cage and received complete follow-up data were followed up for 12 months. 30 cases in group.A were treated by simple Cage interbody fusion combined with pedicle internal fixation; B group of 30 patients with intervertebral Cage front impaction bone grafting with pedicle fixation. Two groups were in the preoperative and postoperative 1, 3,6,12 months of monitoring the following indicators: bone grafting time, intervertebral height, intervertebral motion angle, the Japanese Society of Department of orthopedics (JOA) surgery for low back pain score, Oswestry disability index, fusion rate. Statistical analysis of data using SPSS20.0 software. Results: two Cage bone grafting combined pedicle fixation system for the treatment of lumbar stable disease has obvious effect, two groups of surgical treatment of postoperative intervertebral height, intervertebral activity domain, JOA score, Oswestry disability index were compared with preoperative had significant improvement (P0.05). The efficacy of the two groups of surgery for treatment of lumbar vertebral instability symptoms is exact. And from the fusion of two group rate, two groups of bone graft for lumbar fusion success rate had no significant difference (P0.05), two groups of surgical treatment in the fusion rate. But no difference between the two groups in the postoperative observation of single index or deposit In difference. Maintain the height of intervertebral space in the postoperative intervertebral Cage front impaction bone grafting was significantly higher than that of pure Cage bone graft group (P0.05); and during the operation time of bone grafting, group A was less than Cage in front of the intervertebral impaction bone grafting group. Conclusion: two Cage bone graft combined with vertebra pedicle fixation system for the treatment of lumbar instability effect significantly, while the two group test for the fusion rate was not significantly different, but the two Cage fusion also exist differences. (1) intervertebral Cage front impaction bone grafting group can effectively maintain the height of intervertebral space; (2) vertebral clearance Cage front pressure the bone graft group because of increased bone loss, while expanding the contact area with the endplate bone can be more conducive to integration; (3) Cage simple bone fusion group has more advantages in saving operation time.

【学位授予单位】：成都中医药大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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