下腰椎退行性疾病后路手术中四种不同植骨融合方式的对比研究

发布时间：2018-05-20 07:14

本文选题：植骨融合 + 椎间隙高度　；参考：《南华大学》2015年硕士论文

【摘要】：目的本研究通过对下腰椎退行性疾病后路手术中四种不同的植骨融合方式进行对比,探讨四种不同植骨融合方式的术后疗效,为临床下腰椎退行性疾病后路手术选择可靠的植骨融合方式提供参考。方法收集2010年1月至2014年1月南华大学附属郴州市第一人民医院脊柱外科实施了腰椎后路植骨融合术的478例下腰椎退行性疾病患者的临床资料。根据植骨融合方式不同分为四组,行横突间植骨融合方式的为A组,行椎板关节突间植骨融合方式的为B组,行椎体间单纯植骨融合方式的为C组和行椎体间融合器融合方式的为D组。对其中资料完整的下腰椎退行性疾病患者80例(每组选择20例)为研究对象进行回顾性分析,所有患者均使用了椎弓根螺钉系统内固定。统计并比较四组患者的手术时间、术中出血量、术后引流量、术后住院天数、ODI评分、VAS评分、椎间隙高度及植骨融合率。结果(1)患者的手术时间、术中出血量、术后引流量及术后住院天数各组间比较差异均无统计学差异(p0.05)。(2)各组患者术前、术后ODI评分的临床治疗效果比较及组内术前术后治疗效果比较,四组术前1天的ODI评分差异无统计学差异(p0.05);四组术后12月的ODI评分差异无统计学差异(p0.05)。各组内术前1天和术后12月ODI评分比较,差异有显著的统计学有意义(p0.001)。(3)四组术前1天的VAS评分差异无统计学差异(p0.05);四组术后12月的VAS评分差异无统计学差异(p0.05);各组内术前1天和术后12月VAS评分比较,差异有显著的统计学意义(p0.001)。(4)四组术后3天测量X线片椎间隙高度均无明显变化,差异无统计学意义(p0.05);术后6个月随访时测量各组X线片椎间隙高度,各组椎间隙高度均有丢失,其中A、B组丢失明显,与C、D组比较差异有统计学差异(p0.05)。术后12个月随访时测量各组X线片椎间隙高度,各组椎间隙高度均有丢失,其中A、B、C组丢失明显,D组变化不大,A、B、C三组分别与D组比较差异有统计学差异(p0.05),D组在12个月时明显优于其他3组。(5)四组患者手术后均于术后6个月及12个月进行随访,6个月随访时融合率D组高于A组和B组(p0.05);12月随访时D组融合率高于A组和B组(p0.05),C组融合率高于A组(p0.05)。6个月及12个月随访时D组融合率最高。结论本研究结果提示:(1)下腰椎退行性疾病后路手术中横突间植骨融合方式和椎板关节突间植骨融合方式在术后维持椎间隙高度、植骨融合率上不如椎体间单纯植骨融合方式和椎体间融合器融合方式。(2)椎体间融合器融合方式是一种支撑性的融合方式,植骨融合率高,是下腰椎退行性疾病后路手术中一种较为理想的植骨融合方式。
[Abstract]:Objective to compare the four different bone graft fusion methods in the posterior approach of lumbar degenerative diseases, and to explore the effect of four different bone graft fusion methods. To provide a reference for the selection of reliable bone graft fusion method in posterior surgery of lumbar degenerative diseases. Methods from January 2010 to January 2014, 478 patients with degenerative diseases of lower lumbar vertebrae who underwent posterior lumbar fusion in the Department of Spinal surgery, Chenzhou first people's Hospital, affiliated to South China University, were collected. According to the different ways of bone graft fusion, they were divided into four groups: group A with intertransverse process and group B with interlaminar fusion. Group C and D were performed interbody fusion and interbody fusion respectively. 80 cases of degenerative diseases of lower lumbar vertebrae (20 cases in each group) were retrospectively analyzed. All patients were treated with pedicle screw system fixation. The operation time, intraoperative bleeding volume, postoperative drainage volume, postoperative hospitalization days, ODI score and VAS score, intervertebral space height and bone graft fusion rate were statistically analyzed and compared among the four groups. Results (1) there was no significant difference in the time of operation, the amount of blood loss during operation, the drainage of blood flow after operation and the days of hospitalization after operation among the groups. There was no significant difference in ODI score between the four groups one day before operation and the ODI score at 12 months after operation in the four groups, and there was no significant difference in the ODI score between the four groups at 12 months after operation (p0.05). ODI scores were compared 1 day before operation and 12 months after operation in each group. There was no significant difference in VAS scores between the four groups on the first day before operation (p 0.05), and there was no significant difference in the VAS scores between the four groups in 12 months after operation (p 0.05). The VAS scores in the first day before operation and in 12 months after operation were compared among the four groups. There was no significant change in the height of intervertebral space in X-ray film 3 days after operation, and there was no significant difference in the height of intervertebral space between the four groups, and the height of intervertebral space in each group was lost after 6 months of follow-up, and the height of intervertebral space in each group was lost at 6 months after the operation, and there was no significant difference in the height of intervertebral space between the four groups at 6 months after operation. There was significant loss in group A (P 0.05), compared with group D (P < 0.05). After 12 months follow-up, the height of intervertebral space was measured in each group, and the height of intervertebral space was lost in each group. There was no significant difference between the three groups and D group. There was significant difference between group D and group D at 12 months. (P < 0.05) all the four groups were followed up 6 and 12 months after operation. The fusion rate of group D was higher than that of group A and group B at 6 months follow-up, and the fusion rate of group D was higher than that of group A and group B at 12 months. The fusion rate of group D was higher than that of group A at 6 months and 12 months. Conclusion the results of this study suggest that the intertransverse bone graft fusion and the laminar articular process fusion in the posterior approach of lower lumbar degenerative diseases maintain the height of the intervertebral space after operation. The fusion rate of bone graft is lower than that of simple fusion between vertebrae and fusion of interbody fusion cage. The fusion rate of interbody fusion cage is a kind of supporting fusion mode, and the fusion rate of bone graft fusion is high. It is an ideal method of bone graft fusion in posterior approach for lumbar degenerative diseases.
【学位授予单位】：南华大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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