椎间植骨量对腰椎椎间融合内固定术后融合效果的研究

发布时间：2018-08-15 15:22

【摘要】：目的探讨研究植骨量对于椎间融合成功率及术后疗效的影响。方法选取自2011年1月至2013年12月在我院行腰椎后路手术的腰椎间盘突出症、腰椎管狭窄症患者共98例,均给予采取后路减压椎弓根内固定椎间植骨+cage植入椎间融合手术,术中分别给予植入4 m L、5 m L、6 m L骨粒,给予打压后植入Cage,给予行椎弓根钉棒固定系统加压固定。3组病例分别于术后1个月、3个月、6个月、12个月进行定期随访,进行CT检查及患者功能评分检测,通过对3组患者植骨粒体积、临床效果改善率、植骨融合率、椎间隙高度变化等进行对比,评估不同植骨量椎体植骨融合术后效果。结果术后所有患者均获随访,随访时间为12~28个月,平均21个月。三组VAS评分较术前明显改善,(P0.05),三组间差异无统计学意义(P0.05);ODI评分较术前明显改善(P0.05),三组间差异无统计学意义(P0.05);采用Macnab标准评价临床结果 A组优良率为90.3%,B组为91.0%,C组为91.2%,三组间差异无统计学意义(P0.05);末次随访时A、B、C组椎间隙高度变化分别为(8.7±1.7)mm、(9.8±1.7)mm、(10.1±1.8)mm,差异无统计学意义(P0.05)。术后1年复查腰椎CT片提示:三组椎间融合成功率均较高,B组、C组其椎间植骨融合率明显高于A组,差异具有统计学意义(P0.05)。结论本实验通过观察不同植骨量在术后患者症状改善方面没有明显差异,但随着植骨量的增加,术后影像学评价效果显示植骨量越大早期植骨融合率越高,减小了椎间隙高度丢失。长期随访显示植骨量低于5 m L存在植骨不融合隐患,因此建议椎间植骨量应达5 m L以上。
[Abstract]:Objective to investigate the effect of bone graft volume on the success rate of intervertebral fusion and postoperative efficacy. Methods from January 2011 to December 2013, 98 patients with lumbar intervertebral disc herniation and lumbar spinal stenosis were treated with posterior decompression, pedicle internal fixation and cage implantation. During the operation, 4 ml / L 5 mL / 6 mL bone pellets were implanted respectively, then Cagewas implanted after compression. The patients in the 3 groups were followed up regularly after 1 month, 3 months, 6 months and 12 months after operation with pedicle screw and rod fixation system. Ct examination and functional evaluation of patients were performed to evaluate the effect of bone graft fusion by comparing the volume of bone grafts, the improvement rate of clinical effect, the fusion rate of bone graft and the height of intervertebral space in the three groups. Results all patients were followed up for 12 ~ 28 months (mean 21 months). The scores of VAS in the three groups were significantly improved (P0.05), and there was no significant difference between the three groups (P0.05), and there was no significant difference among the three groups (P0.05), and there was no significant difference among the three groups (P0.05), and the excellent and good rate of group A was 91.0% by using the Macnab standard to evaluate the clinical results. There was no significant difference among the three groups (P0.05), and the height of intervertebral space in group C was (8.7 卤1.7) mm, () 9.8 卤1.7) mm, (10.1 卤1.8) mm at the last follow-up (P0.05). One year after operation, the results showed that the success rate of intervertebral fusion in three groups was higher than that in group B and C, and the rate of bone graft fusion was significantly higher than that in group A (P0.05). Conclusion there is no significant difference in the improvement of postoperative symptoms by observing the different amount of bone grafts, but with the increase of the amount of bone grafts, the effect of imaging evaluation after operation shows that the larger the amount of bone grafts, the higher the fusion rate of bone grafts in the early stage. The loss of intervertebral space height is reduced. Long-term follow-up showed that the bone graft volume below 5 mL had the hidden trouble of bone graft non-fusion, so it was suggested that the intervertebral bone graft volume should be more than 5 mL.
【作者单位】：河北省保定市第一医院骨外科;
【分类号】：R687.3

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