自體骨腰椎椎間融合器在后路腰椎椎間融合術治療退行性腰椎疾患的效果

張振山 黃福立 李健 朱豪東

[摘要] 目的研究自體骨腰椎椎間融合器（自體骨 cage）在后路腰椎椎間融合術治療退行性腰椎疾患的臨床效果。方法選取2019年 4月至2020年 4月中山市中醫院、廣州醫科大學附屬第五醫院收治的退行性腰椎疾患行后路椎間融合內固定手術患者80例，采用隨機數字表法將其分為觀察組（ n=38）和對照組（ n=42），觀察組采用自體骨腰椎椎間融合器、對照組采用人工融合器;觀察兩組融合器聯合內固定術治療退行性腰椎疾患的術中出血量、手術時間、術中并發癥等各項臨床指標、植骨融合率、相對椎間隙高度等影像學指標及腰腿痛視覺模擬評分（VAS）、Oswestry功能障礙指數（ODI）等臨床療效評分，收集相關數據進行對比分析。結果兩組術中出血量、手術時間、術中并發癥比較，差異無統計學意義（ P > 0.05），兩組術后 3個月 VAS 評分與 ODI 評分低于術前，差異有統計學意義（ P <0.05）;術后3 個月、6個月、1年時，兩組 VAS 和 ODI 評分比較，差異無統計學意義（P >0.05）;術后椎間隙高度較術前增加，差異有統計學意義（P <0.05），術后3 個月、6個月、1年時兩組椎間隙高度有丟失，差異均無統計學意義（ P >0.05）;術后1 年，兩組植骨融合率比較，差異無統計學意義（ P >0.05）。結論自體骨腰椎椎間融合器結合椎弓根螺釘內固定具有生物力學穩定性，與人工椎間融合器結合椎弓根釘內固定均能有效治療退行性腰椎疾患，融合率高。

[關鍵詞] 自體骨;融合器;生物力學;椎弓根螺釘

[中圖分類號] R687.3??? [文獻標識碼] A??? [文章編號] 2095-0616（2022）06-0018-05

Effect of autogenous bone lumbar intervertebral fusion cage for posterior lumbar interbody fusion in the treatment of lumbardegenerative diseases

ZHANG? Zhenshan????? HUANG? FuliLI? JianZHU? Haodong

1. Department of Spine and Orthopedics， Zhongshan Hospital of Traditional Chinese Medicine， Guangdong， Zhongshan 528400， China;2. Department of Spine， the Fifth Affiliated Hospital of Guangzhou Medical University， Guangdong， Guangzhou 510700， China

[Abstract] Objective To study the clinical efficacy of autologous bone lumbar intervertebral fusion cage （autologous bone cage） for posterior lumbar interbody fusion in the treatment of lumbar degenerative diseases. Methods A total of 80 patients with lumbar degenerative diseases undergoing posterior lumbar interbody fusion and internal fixation surgery admitted to Zhongshan Hospital of Traditional Chinese Medicine and the Fifth Affiliated Hospital of Guangzhou Medical University from April 2019 to April 2020 were selected and divided into two groups according to the random number table method. The obsevation group （n=38） received fusion procedure with autologous bone cage， while the control group （n=42） received fusion procedure with artificial interbody fusion cage. The intraoperative bleeding volume， operation duration， intraoperative complications and other clinical indexes， bone graft fusion rate， relative lumbar space height and other imaging indexes， as well as the Visual Analogue Scale （VAS） score for lumbocrural pain and Oswestry disability index （ODI） and other clinical efficacy scores of the two groups were observed in the treatment of lumbar degenerative diseases by the two kinds of fusion procedures combined with internal fixation， and the relevant data were collected for comparative analysis. Results There were no statistically significant differences between the two groups in intraoperative bleeding volume， operation duration， and intraoperative complications （P >0.05）. The VAS scores and ODI scores in both groups at 3 months after surgery were lower than those before surgery， with statistically significant differences （P <0.05）， while there were no statistically significant differences between the two groupsin the VAS and ODI scores at 3 months， 6 months， and 1 year after surgery （P >0.05）. There was an increase of lumbar space height in both groups after surgery， with statistically significantly different from the lumbar space height in both groups before surgery （P < 0.05）. In addition， there was a loss of lumbar space height in both groups at 3 months， 6 months and 1 year after surgery， with no statistically significant differences （P > 0.05）.1 year after surgery， there was no significant difference in the fusion rate between the two groups （P > 0.05） Conclusion The combination of autogenous bone cage and vertebral pedicle screw internal fixation shows biomechanical stability， and the combination of fusion procedure with artificial interbody fusion cage and vertebral pedicle screw internal fixation also can effectively treat lumbar degenerative diseases， with a high fusion rate.

[Key words] Autogenous bone; Fusion cage; Biomechanical; Vertebral pedicle screw

退行性腰椎疾患是在脊柱外科臨床中較為常見的疾患，該疾病可導致患者行走困難、腰腿疼痛，嚴重影響患者的生活質量，而后路椎間植骨融合是目前最為常見的治療退行性腰椎滑脫的術式之一 [1-2]。……