单枚与双枚椎间融合器治疗退变性腰椎失稳症的临床研究

发布时间：2018-08-12 09:24

【摘要】：背景:后路椎体间融合手术治疗退变性腰椎失稳症是临床应用较为普遍的一种方法。经典的术式是双枚椎间融合器进行椎间融合,其要求操作空间大,术野开阔,双侧关节突难以保留,容易破坏脊柱后方结构、椎旁肌群及椎管内组织,并且手术时间较长、术中出血量大、花费高。因此,有必要寻求一种可以减少后柱结构及椎旁肌肉的破坏性,而又不减少椎间融合率的有利方法,更好地为临床工作服务。目的:对比分析单枚与双枚椎间融合器在退变性腰椎失稳症后路椎体间融合手术中的治疗效果,更好地为临床工作服务。材料与方法:自2011年8月至2013年12月,选取山东省文登整骨医院脊柱脊髓科行单节段后路减压椎间融合内固定治疗退变性腰椎失稳症的手术患者共198例,按使用Cage的数目将其分为单枚组(A组,110例)与双枚组(B组,88例)进行严格随访、跟踪,获得其术后两年或两年以上的临床及影像学资料进行比对、分析。结果:两组病例间的年龄、性别、发病节段、术后随访时间的差别无统计学意义(P0.05),A组病例中的手术时间、术中出血量、平均住院花费低于B组(P0.05),两组病例术后JOA评分、ODI评分、椎间融合率、椎间隙高度的差异均无统计学意义(P0.05)。结论:单、双枚椎间融合器治疗退变性腰椎失稳,均可达到满意效果。而与双枚椎间融合器相比,单枚融合器植入操作要求简单,手术创伤小,可更大程度保留脊柱后方结构,由于少用一枚融合器,花费更少。
[Abstract]:Background: posterior interbody fusion is a common method in the treatment of degenerative lumbar instability. The classical operation is to perform intervertebral fusion with two intervertebral fusion cages, which require large operation space, open surgical field, difficult to preserve bilateral articular processes, easily destroy the posterior structure of the spine, paraspinal muscle group and intraspinal tissue, and have a longer operation time. The amount of intraoperative bleeding is large and the cost is high. Therefore, it is necessary to find a method that can reduce the destructiveness of posterior column structure and paraspinal muscles without reducing the rate of intervertebral fusion, so as to serve the clinical work better. Objective: to compare and analyze the effect of single and double interbody fusion cage in posterior interbody fusion of degenerative lumbar instability. Materials and methods: from August 2011 to December 2013, 198 patients with degenerative lumbar instability were selected from Department of Spine and Spinal Cord, Wendeng whole Bone Hospital of Shandong Province, who were treated with single segment posterior decompression and interbody fusion and internal fixation. According to the number of Cage, they were divided into single group (group A, n = 110) and double group (group B, n = 88). Results: there was no significant difference between the two groups in age, sex, level of onset, postoperative follow-up time (P0.05). The operative time, intraoperative bleeding volume, average hospitalization cost were lower in group A than those in group B (P0.05), and the JOA scores of two groups were significantly lower than those in group B (P0.05). There was no significant difference in intervertebral fusion rate and intervertebral space height (P0.05). Conclusion: both single and double interbody fusion cages can achieve satisfactory results in the treatment of degenerative lumbar instability. Compared with two intervertebral fusion cages, the single fusion cage requires simple operation, less surgical trauma, and can preserve the posterior structure of the spine to a greater extent, because of the less use of one fusion cage, the cost is even less.
【学位授予单位】：山东中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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