不同椎间植骨融合方式治疗单节段腰椎管狭窄症的疗效对比

doi:10.3969/j.issn.1006-5725.2019.16.023

摘要/Abstract

摘要： 目的对比后路椎体间自体骨+椎间融合器和自体骨+同种异体骨两种植骨融合方式在治疗单节段腰椎管狭窄症（lumbar spinal stenosis,LSS）方面的疗效。方法回顾性分析2016年8月至2017年8月于我科行单节段LSS手术治疗的患者病例,其中接受后路自体骨+椎间融合器椎体间植骨融合的患者 66 例（对照组）,接受自体骨+同种异体骨椎体间植骨融合的患者58 例（观察组）。术后随访15~27个月,平均20.6月,比较两种植骨融合方式手术时间、术中出血量、术后引流量、住院天数、并发症、椎间隙高度、植骨融合率和治疗费用。采用视觉疼痛模拟评分（visual analogue scale,VAS）、腰椎JOA 评分（Japanese Orthopaedic Association scores）、Oswestry功能障碍指数（Oswestry disabilityindex,ODI）对手术疗效进行评定,比较两组术前、术后1 d、末次随访椎间隙、椎间孔高度以及腰椎前凸角,并计算记录丢失情况。结果两组患者在手术时间、术中出血量、术后引流量、住院天数、并发症、椎间隙高度及植骨融合率方面均无显著性差异（P > 0.05）;两组患者术后腰腿痛 VAS 评分、腰椎JOA 评分、ODI 指数较术前均明显改善（P < 0.01）,组间比较术后7 d,术后1、3、6、12个月腰腿痛 VAS 评分、JOA 评分、ODI 指数无显著性差异（P > 0.05）;观察组治疗费用（30 316.6 ± 826.8）元,对照组医疗费用（35 356.5 ± 916.2）元,观察组明显低于对照组（P < 0.01）;两组术后1 d、末次随访椎间隙、椎间孔高度以及腰椎前凸角均显著高于术前,且观察组椎间隙、椎间孔高度丢失小于对照组,差异具有统计学意义（P < 0.05）,两组腰椎前凸角丢失差异无统计学意义（P > 0.05）。结论后路椎体间自体骨+椎间融合器和自体骨+同种异体骨两种植骨融合方式在治疗单节段LSS方面均能获得满意的临床疗效,自体骨+同种异体骨椎间植骨融合方式在降低治疗费用,节约医疗成本方面更具优势,但自体骨+椎间融合器椎间植骨融合方式能有效减少远期椎间隙、椎间孔高度丢失。

关键词: 椎间植骨融合, 腰椎管狭窄症, 椎间隙高度, 椎间孔高度, 腰椎前凸角

Abstract: Objective To compare the differences in surgical effects of posterior lumbar interbody autologous bone plus cage graft fusion and autologous bone plus autograft bone graft fusion for single segment lumbar spinal stenosis. Methods One hundred and twenty-four patients with single segment lumbar disc herniation who underwent interbody fusion surgery from August 2016 to August 2017 were included in this retrospective study. The patients were divided into posterior lumbar interbody autologous bone plus cage graft fusion （n = 66, control group） and autologous bone plus autograft bone graft fusion （n = 58, observation group） groups. After surgery, the patients were followed up for an average of 20.6 months （range, 15 to 27 months）. The operation time, intraoperative blood loss, postoperative area flow, hospitalization, complications, disc height, fusion rate and treatment cost were recorded and compared between two groups. Curative effect was evaluated by VAS score, JOA score and ODI score. The preoperative, postoperative 1 day, last follow-up intervertebral space, intervertebral foramen height and lumbar lordosis angle of two groups were compared and the loss of records was calculated. Results Perioperative correlation such as the operation time, intraoperative blood loss, postoperative area flow, hospitalization, complications, disc height and fusion rate were similar between the two groups （P > 0.05）. After treatment, the VAS scores, JOA scores, and ODI in the two groups were significantly improved compared to preoperative data （P < 0.01）. However, there was no significant difference between the groups in the same period （P > 0.05）. The treatment cost of the observation group was 30316.6 ± 826.8 yuan, and the control group was 35356.5 ± 916.2 yuan, which was significantly lower than that of the control group （P < 0.01）. The intervertebral space, intervertebral foramen height and lumbar lordosis angle at 1 day after surgery and the last follow-up were significantly higher in the two groups than in the preoperative. The loss of intervertebral space and intervertebral foramen height in the study group was smaller than that in the control group, and the difference was statistically significant （P < 0.05）. There was no significant difference in lumbar lordosis angle loss between the two groups （P > 0.05）. Conclusion Both posterior lumbar interbody autologous bone plus cage graft fusion and autologous bone plus autograft bone graft fusion are of benefit to single segment LSS. Meanwhile, autologous bone plus autograft bone graft fusion is more promising in reducing treatment cost and saving medical cost. However, autogenous bone plus interbody fusion cage interbody bone graft fusion can effectively reduce the loss of long-term intervertebral space and intervertebral foramen height.

Key words: interbody bone graft fusion, lumbar spinal stenosis, intervertebral space height, intervertebral foramen height, lumbar lordosis angle

王雅辉, 刘正蓬, 褚立, 明颖, 张义龙, 孙志杰, 王建华, 李哲, 孙贺. 不同椎间植骨融合方式治疗单节段腰椎管狭窄症的疗效对比[J]. 实用医学杂志, 2019, 35(16): 2619-2623.

WANG Yahui, LIU Zhengpeng, CHU Li, MING Ying, ZHANG Yilong, SUN Zhijie, WANG Jianhua, LI Zhe, SUN He. Comparison of surgical effects of different intervertebral bone graft fusion methods on single segment lumbar spinal stenosis[J]. The Journal of Practical Medicine, 2019, 35(16): 2619-2623.

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