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[1]顧榮勝,董松林,陳大志,等.2種植骨融合方式治療退變性腰椎管狹窄 伴腰椎滑脫的早期療效比較[J].中醫(yī)正骨,2011,23(03):19-22.
　GU Rong-sheng*,DONG Song-lin,CHEN Da-zhi.*.comparison of early curative effects of two kinds of fusion methods on degenerative lumbar spinal stenosis with spondylolisthesis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2011,23(03):19-22.
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2種植骨融合方式治療退變性腰椎管狹窄 伴腰椎滑脫的早期療效比較()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第23卷
期數(shù):
2011年03期
頁碼:
19-22
欄目:
臨床研究
出版日期:
2011-03-30

文章信息/Info

Title:
comparison of early curative effects of two kinds of fusion methods on degenerative lumbar spinal stenosis with spondylolisthesis
作者:
顧榮勝; 董松林; 陳大志; 祁兆建; 范廣峰; 王富貴; 孟慶國; 唐華
江蘇省鹽城市中醫(yī)院,江蘇 鹽城 224001
Author(s):
GU Rong-sheng*; DONG Song-lin; CHEN Da-zhi.*
Traditional Chinese Medical Hospital of Yancheng City,Yancheng 224001,Jiangsu,China
關(guān)鍵詞:
椎管狹窄 脊椎滑脫 腰椎 脊柱融合術(shù)
Keywords:
Spinal stenosis;  Spondylolysis;  Lumbar vertebrae;  Spinal fusion
摘要:
目的:比較椎管減壓、椎弓根螺釘輔助橫突間植骨融合和椎管減壓、椎弓根螺釘輔助后路Cage椎間植骨融合治療退變性腰 椎管狹窄伴腰椎滑脫的早期療效。方法:回顧性分析2004年3月至2008年3月我院采用椎管減壓、椎弓根螺釘輔助橫突間植骨融合 治療的18例(Ⅰ組)及采用椎弓根螺釘輔助后路Cage椎間植骨融合治療的14例(Ⅱ組)退變性腰椎管狹窄伴腰椎滑脫患者的病歷資 料,從患者的腰椎功能改善情況、植骨融合情況、術(shù)中情況及并發(fā)癥發(fā)生情況等方面進(jìn)行比較。結(jié)果:①2組患者術(shù)前、術(shù)后1年 及術(shù)后1年與術(shù)前JOA評分差值比較,差異均無統(tǒng)計學(xué)意義(t=1.101,P=0.280; t=0.462,P=0.563; t=0.585,P=0.883)。②Ⅰ組16 例患者植骨融合,2例未融合; Ⅱ組患者植骨全部融合。2組間植骨融合情況比較,差異無統(tǒng)計學(xué)意義(P=0.492)。③Ⅰ組患者術(shù)中 出血量及手術(shù)時間均少于Ⅱ組,差異有統(tǒng)計學(xué)意義(t=9.269,P=0.000; t=35.957,P=0.000); Ⅰ組2例出現(xiàn)下肢麻木,3例發(fā)生硬膜 撕裂,Ⅱ組5例出現(xiàn)下肢麻木,6例發(fā)生硬膜撕裂,2組并發(fā)癥發(fā)生情況比較,差異無統(tǒng)計學(xué)意義(P=0.195,P=0.132)。結(jié)論:對于退變 性腰椎管狹窄伴腰椎滑脫患者,行椎管減壓、椎弓根螺釘固定后采用橫突間植骨融合與Cage椎間融合2種植骨方式療效相當(dāng),但采 用后路Cage椎間植骨融合創(chuàng)傷較大,手術(shù)時間長,失血量大。對伴有Ⅰ、Ⅱ度滑脫者,只要術(shù)中正確處理植骨床、充分植骨,橫突 間融合不失為首選方案。
Abstract:
Objective:To compare the early curative effects of vertebral canal decompression plus intertransverse bone fusion with support from pedicle screw with that of vertebral canal decompression plus posterior lumbar interbody fusion with support from Cage and pedicle screw on degenerative lumbar spinal stenosis(DLSS)combined with degenerative lumbar spondylolisthesis(DLS).Methods:The medical records of 32 DLSS&DLS patients treated in our hospital from march 2004 to march 2008 were analyzed retrospectively.18 cases in groupⅠwere treated through vertebral canal decompression plus intertransverse bone fusion with support from pedicle screw,while the others in groupⅡwere treated through vertebral canal decompression plus posterior lumbar interbody fusion with support from Cage and pedicle screw.Some indexes were compared between the 2 groups to evaluated the improvement of lumbar function, effect of the bone graft fusion,intraoperative conditions and complications.Results:①There was no statistical difference of JOA scores between the 2 groups before operation and 1 year after operation,so did the difference of preoperative JOA scores and JOA scores 1 year after the operation(t=1.101,P=0.280; t=0.462,P=0.563; t=0.585,P=0.883).②16 patients achieved successful bone graft fusion in groupⅠand the other 2 patients encountered failure,while no abortive cases were found in groupⅡ.There was no statistical difference in effect of the bone graft fusion between the 2 groups(P=0.492).③ Amount of blood loss and operation time of patients in groupⅠwere lower than those of patients in groupⅡ (t=9.269,P=0.000; t=35.957,P=0.000).In groupⅠ,numbness of lower limb occurred in 2 cases and dural tear occurred in 3 cases; while in groupⅡ,the above 2 complications occured in 5 and 6 cases respectively; there was no statistical difference in ratio of complications between the 2 groups (P=0.195,P=0.132).Conclusion:Compared with the method of vertebral canal decompression plus intertransverse bone fusion with support from pedicle screw,the method of vertebral canal decompression plus posterior lumbar interbody fusion with support from Cage and pedicle screw has approximate curative effect on DLSS combined with DLS,but the latter method has the disadvantages as more severe injury,longer duration of operation and more intraoperation blood loss.Therefore,the former method is regarded as the preferred solution to DLSS combined with DLS ofⅠandⅡdegree so far as such measures are taken as correct handling of grafting bed and sufficient bone graft during the operation.

參考文獻(xiàn)/References:

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更新日期/Last Update: 2011-03-30