中国组织工程研究

中国组织工程研究 ›› 2011, Vol. 15 ›› Issue (17): 3079-3084.doi: 10.3969/j.issn.1673-8225.2011.17.011

• 骨科植入物 orthopedic implant • 上一篇    下一篇

金属植入物作用下腰椎后路3种融合方式的比较

赵  疆1，楚  戈1，项泽文1，白靖平2，何祖胜2，李永凯3   

  1. 新疆维吾尔自治区中医医院，1脊柱一科，3针灸科，新疆维吾尔自治区乌鲁木齐市  830000；2新疆医科大学附属肿瘤医院骨科，新疆维吾尔自治区乌鲁木齐市  830000
  • 收稿日期:2010-10-09 修回日期:2010-12-25 出版日期:2011-04-23 发布日期:2011-04-23
  • 通讯作者: 李永凯，主治医师，讲师，新疆维吾尔自治区中医医院针灸科，新疆维吾尔自治区乌鲁木齐市830000 xiaochu138.@ sina.com
  • 作者简介:赵疆★，男，1971年生，广东省人，汉族，2006年新疆医科大学毕业，硕士，副主任医师，主要从事脊柱外科研究。 xjzhaojiang@ 163.com

Comparison of three methods for posterior lumbar fusion during the implantation of metal implants

Zhao Jiang1, Chu Ge1, Xiang Ze-wen1, Bai Jing-ping2, He Zu-sheng2, Li Yong-kai3   

  1. 1First Department of Spinal Cord, 3Department of Acupuncture, Xinjiang Hospital of Traditional Chinese Medicine, Urumqi  830000, Xinjiang Uygur Autonomous Region, China; 2Departmnt of Orthopedics, Tumor Hospital of Xinjiang Medical University, Urumqi  830000, Xinjiang Uygur Autonomous Region, China
  • Received:2010-10-09 Revised:2010-12-25 Online:2011-04-23 Published:2011-04-23
  • Contact: Li Yong-kai, Attending physician, Lecturer, Department of Acupuncture, Xinjiang Hospital of Traditional Chinese Medicine, Urumqi 830000, Xinjiang Uygur Autonomous Region, China xiaochu138.@sina. com
  • About author:Zhao Jiang★, Master, Associate chief physician, First Department of Spinal Cord, Xinjiang Hospital of Traditional Chinese Medicine, Urumqi 830000, Xinjiang Uygur Autonomous Region, China xjzhaojiang@163. com

PDF

668

被引次数

7

摘要：

背景：融合是腰椎减压椎弓根螺钉置入内固定后稳定运动节段的重要方式，经典的融合方式包括后外侧融合、后方椎间融合、后外侧融合并后方椎间融合。很多研究报道过几种融合方式的优势、技术要求、临床疗效和融合后并发症，但结论各异，很难明确最佳融合方式。
目的：比较后外侧融合、后方椎间融合、后外侧融合并后方椎间融合的疗效差异，以期寻求最佳融合方式。
方法：选择167例因退变性腰椎疾病行1个或2个节段融合，随访时间最短为3年的患者，分为3组，后外侧融合组62例，后方椎间融合组57组，后外侧融合+后方椎间融合组48例。通过目测类比评分、ODQ问卷和Kirkaldy-Willis 量表评价患者的腰痛、下肢疼痛和功能状况，并进行影像学评价，包括椎间盘高度、腰前凸、病变节段间角度、融合情况及融合后并发症。
结果与结论：最后1次随访结果表明，后外侧融合组患者中50例(80.7%)疗效优良，后方椎间融合组患者中50例(87.8%)疗效优良，后外侧融合+后方椎间融合组41例(85.5%)疗效优良，3组差异无显著性意义(P = 0.704)。3种融合方式都明显改善了椎间盘高度(P < 0.05)，其中后外侧融合组椎间盘高度丢失最多，腰前凸和节段间角度明显增大，3种融合方式的节段间角度变化差异有显著性意义(P < 0.05)。最后1次随访时，3种融合方式的不融合率差异无显著性意义(P > 0.05)。治疗后并发症包括3例深部感染，4例暂时神经麻痹，1例永久神经麻痹，6例取骨处疼痛。提示3组融合方式在临床疗效和融合率方面无明显差异，后方椎间融合比后外侧融合能更好维持矢状面平衡。单纯后方椎间融合在缩短手术时间、减少失血量及避免取骨处疼痛方面有明显优势。

关键词: 脊柱融合, 腰椎, 退变, 后外侧融合, 后方椎间融合

Abstract:

BACKGROUND: Classic fusion methods include posterolateral fusion (PLF), posterior lumbar interbody fusion (PLIF), PLF combined with PLIF. Many studies have reported the advantage, technical requirements, clinical efficacy and complications of several fusion methods, but it is difficult to select the best fusion method.
OBJECTIVE: To compare the outcomes of PLF, PLIF, and PLF+PLIF and to find the optimal method.
METHODS: A total of 167 patients who underwent 1 or 2-level fusion surgery because of degenerative lumbar disease were studied. Minimum follow-up period was 3 years. The patients were randomized into three treatment groups: group 1 (PLF; n=62); group 2 (PLIF; n=57); and group 3 (PLF+PLIF; n=48). A visual analog scale, the Oswestry Disability Questionnaire, and Kirkaldy-Willis criteria were used to measure low back pain, leg pain, and disability. For radiologic evaluation, disc height, lumbar lordosis, segmental angle, and bone union were examined. Postoperative complications were also analyzed.
RESULTS: At the last follow-up, good or excellent results were obtained in 50 cases of PLF (80.7%), 50 cases of PLIF (87.8%), and 41 cases of PLF+PLIF (85.5%). No statistical differences were found among the three groups (P=0.704). All methods indicated significant improvement in the disc height (P < 0.05), with PLF having the highest loss in disc height. Lumbar lordosis and segmental angle increased significantly, and improvement of the segmental angle in the three fusion methods had statistically significant differences. The nonunion rates at the last follow-up in the three fusion groups were not statistically significant, with 8% in group 1, 5% in group 2, and 4% in group 3 (P > 0.05). Complications included deep infection in 3 cases, transient nerve palsy in 4, permanent nerve palsy in 1, and donor site pain in 6. No significant differences in clinical results and union rates were found among the 3 fusion methods. PLIF had better sagittal balance than PLF. PLIF had advantages of the elimination of donor site pain, shorter operating time, and less blood loss.

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