Internal fixation by nail-stick system and posterior lumbar interbody fusion with modified autogeneous bone for lumbar degenerative disease

doi:10.3969/j.issn.2095-4344.2014.53.010

Abstract

Abstract:

BACKGROUND: The modified autogeneous bone fusion refers to the combination of cancellous bone and cortical bone. Their combination plays a complementary role in lumbar spinal fusion. This can ensure the fusion rate and reduce the excessive loss of intervertebral height.
OBJECTIVE: To study the curative effect of internal fixation by nail-stick system and posterior lumbar interbody fusion with modified autogeneous bone for lumbar degenerative disease.
METHODS: According to different operation methods, 60 patients with lumbar degenerative disease were equally divided into modified group and control group. The modified group was treated with internal fixation by nail-stick system and posterior lumbar interbody fusion with modified autogeneous bone, while control group was treated with internal fixation by nail-stick system and Cage posterior lumbar interbody fusion. All patients were detected at 3, 6, 12 months of follow-ups. The postoperative complications, improvement rate of low back pain, intervertebral height and lumbar lordosis angle after operation were observed and compared in two groups.
RESULTS AND CONCLUSION: All the patients have better life quality and significant improvement in low back pain after surgery, when compared to before surgery. Fewer postoperative complications happen to patients in the modified group. There is no significant difference in intervertebral height and lumbar lordosis angle between the two groups. Internal fixation by nail-stick system and posterior lumbar interbody fusion with modified autogeneous bone is similar to internal fixation by nail-stick system and Cage posterior lumbar interbody fusion, but modified autogeneous bone has less complication than Cage in a long-term follow-up.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

全文链接：

Key words: internal fixator, lumbar vertebrae, bone transplantation

CLC Number:

R318

Zhang Xue-liang, Wang Wen-ji. Internal fixation by nail-stick system and posterior lumbar interbody fusion with modified autogeneous bone for lumbar degenerative disease[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(53): 8580-8583.

Figures/Tables 1

2.1 参与者数量分析按意向性处理，纳入单纯腰椎退行性变患者60例，分为2组，全部进入结果分析，无脱落。 2.2 基线资料比较 2组患者性别、年龄等基线资料比较差异无显著性意义(P > 0.05)，具有可比性。 2.3 治疗相关参数及相关并发症改良组平均手术时间165 min(110-230 min)，对照组组平均手术时间176 min (113-246 min)。2组的围手术期平均出血量分别为465 mL (376-678 mL)及450 mL(365-720 mL)。2组的平均术后住院时间分别为12 d(6-21 d)及15 d(7-24 d)。2组间的平均手术时间、平均出血量、平均住院时间差异均无显著性意义(P > 0.05)。 2组中患者中手术切口均无感染，改良组中2例患者手术切口脂肪液化，经加强换药后，切口均一期愈合；对照组中切口均一期愈合。改良组中术后有2例患者术后出现腰腿痛，加强用药后症状消失；而对照组中有5例患者出现腰腿痛，3例患者经加强用药后症状消失，2例患者症状持续，考虑为术中神经根过度牵拉引起。改良组中无硬脊膜损伤发生；对照组中1例发生硬脊膜损伤，经术后伤口加压包扎，保持头低脚高位卧床，并给予高渗盐水静滴等对症处理后均未发生顽固性头痛、慢性脑脊液漏等并发症。2组患者均无术中大出血、脊髓、神经损伤，无内固定器断裂、钉棒移位发生，无Cage、植骨块下沉或移位。 2.4 椎间隙高度及腰椎前凸角测量结果术前、术后3个月及末次随访时的椎间隙高度、腰椎前凸角分别见表1。椎间隙高度：改良组术后3个月、末次随访与术前比较差异有显著性意义(P < 0.05)，末次随访与术后3个月比较差异无显著性意义(P > 0.05)；对照组术后3个月、末次随访与术前比较差异有显著性意义(P < 0.05)，末次随访与术后3个月比较差异无显著性意义(P > 0.05)。腰椎前突角：改良组术后3个月、末次随访与术前比较差异有显著性意义(P < 0.05)，末次随访与术后3个月比较差异无显著性意义(P > 0.05)；对照组术后3个月、末次随访与术前比较差异有显著性意义(P < 0.05)，末次随访与术后3个月比较差异无显著性意义(P > 0.05)。 2.5 JOA评分及改善率术前及术后3个月随访时的JOA评分见表2，JOA改善率见表3。 2组患者术后3个月JOA评分均较术前明显改善，2组末次随访JOA评分较术前比较差异有显著性意义(P < 0.05)，两组之间JOA评分比较差异无显著性意义(P > 0.05)，改良组JOA改善率优良率达96%，对照组达93%，2组比较差异无显著性意义(P > 0.05)。"

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