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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:

第26卷

期數(shù):

2014年10期

頁(yè)碼:

20-24

欄目:

脊柱退行性疾患

出版日期:

2014-10-30

文章信息/Info

Title:

A retrospective trial of interbody fusion with one versus two cages combined with pedicle screw internal fixation for treatment of lumbar spondylolisthesis

作者:

賀瑞; 尚希福; 張文志; 李旭; 許翔; 胡業(yè)豐; 段麗群; 葛暢; 程鵬

安徽醫(yī)科大學(xué)附屬省立醫(yī)院,安徽 合肥 230001

Author(s):

He Rui^*; Shang Xifu; Zhang Wenzhi; Li Xu; Xu Xiang; Hu Yefeng; Duan Liqun; Ge Chang;  Cheng Peng.^*

The Provincial Hospital Affiliated to Anhui Medical University,Hefei 230001,Anhui,China

關(guān)鍵詞:

脊椎滑脫 腰椎 內(nèi)固定器 骨移植 脊柱融合術(shù) 椎弓根釘 椎間融合器

Keywords:

Spondylolysis;  Lumbar vertebrae;  Internal fixations;  Bone transplantation;  Spinal fusion;  Pedicle screw;  Interbody fusion cage

摘要:

目的:比較單枚與雙枚椎間融合器植骨融合聯(lián)合椎弓根釘棒系統(tǒng)內(nèi)固定治療腰椎滑脫的臨床療效及安全性。方法:回顧性 分析134例腰椎滑脫患者的病例資料,其中采用單枚椎間融合器植骨融合聯(lián)合椎弓根釘棒系統(tǒng)內(nèi)固定71例(單枚組),采用雙枚椎間 融合器植骨融合聯(lián)合椎弓根釘棒系統(tǒng)內(nèi)固定63例(雙枚組); MeyerdingⅠ度滑脫40例,Ⅱ度滑脫57例,Ⅲ度滑脫37例; L_{3～ 4}滑脫10例,L_4～5滑脫94例,L₅S₁滑脫30例。記錄并比較2組患者的手術(shù)時(shí)間、術(shù)中 出血量、術(shù)后引流量、腰椎疼痛視覺(jué)模擬評(píng)分、腰椎Oswestry功能障礙指數(shù)、椎間植骨融合率及術(shù)后并發(fā)癥的發(fā)生情況。結(jié)果: ①一般指標(biāo)。單枚組的手術(shù)時(shí)間、術(shù)中出血量及術(shù)后引流量均小于雙枚組[(90.0±25.0)min,(115.0±35.0)min,t=- 4.797,P=0.000;(210.0±100.0)mL,(320.0±120.0)mL,t=-5.786,P=0.000;(80.0±50.0)mL,(130.0±45.0) mL,t=-6.054,P=0.000]。術(shù)后6個(gè)月,單枚組椎間植骨融合71例,雙枚組椎間植骨融合63例; 2組患者椎間植骨融合率比較,差異無(wú) 統(tǒng)計(jì)學(xué)意義(P=1.000)。②腰椎疼痛視覺(jué)模擬評(píng)分。術(shù)后4周,2組患者的腰椎疼痛視覺(jué)模擬評(píng)分均較術(shù)前降低[(8.0±1.3)分 ,(2.3±0.8)分,t=31.465,P=0.000;(8.1±1.1)分,(2.2±1.0)分,t=31.501,P=0.000]; 2組患者腰椎疼痛視覺(jué)模擬 評(píng)分下降幅度比較,差異無(wú)統(tǒng)計(jì)學(xué)意義[(5.7±1.2)分,(5.9±1.3)分,t=-0.926,P=0.356]。③腰椎Oswestry功能障礙評(píng) 分。術(shù)后4周,2組患者的腰椎Oswestry功能障礙評(píng)分均較術(shù)前降低[(35.0±4.5)分,(8.1±1.4)分,t=48.096,P=0.000; (34.5±4.3)分,(8.0±1.1)分,t=47.390,P=0.000]; 2組患者腰椎Oswestry功能障礙評(píng)分下降幅度比較,差異無(wú)統(tǒng)計(jì)學(xué) 意義[(26.9±4.8)分,(26.5±3.9)分,t=0.525,P=0.600]。④安全性指標(biāo)。2組患者均未發(fā)生內(nèi)固定松動(dòng)、斷裂。單枚 組1例患者發(fā)生腦脊液漏; 雙枚組7例患者發(fā)生腦脊液漏,5例患者發(fā)生感染。單枚組并發(fā)癥發(fā)生率低于雙枚組 (χ²=11.856,P=0.001)。結(jié)論:對(duì)于MeyerdingⅠ、Ⅱ、Ⅲ度腰椎滑脫患者而言,雖然單枚椎間融合器植骨融合聯(lián)合 椎弓根釘棒系統(tǒng)內(nèi)固定與雙枚椎間融合器植骨融合聯(lián)合椎弓根釘棒系統(tǒng)內(nèi)固定在緩解腰椎疼痛、改善腰椎功能及提高椎間植骨 融合率方面無(wú)明顯差異,但單枚椎間融合器植骨融合聯(lián)合椎弓根釘棒系統(tǒng)內(nèi)固定具有手術(shù)時(shí)間短、出血量少、并發(fā)癥少等優(yōu)點(diǎn), 是治療腰椎滑脫的一種較理想的方法,值得臨床推廣應(yīng)用。

Abstract:

Objective:To compare the clinical curative effects and safety of interbody fusion with one versus two cages combined with pedicle screw internal fixation for treatment of lumbar spondylolisthesis.Methods:The medical records of 134 patients with lumbar spondylolisthesis were analyzed retrospectively.Seventy-one patients(one-cage group)were treated with interbody fusion with one cage combined with pedicle screw internal fixation,while the others(two-cage group)were treated with interbody fusion with two cages combined with pedicle screw internal fixation.The lumbar spondylolisthesis belonged to Meyerding typesⅠ(40),Ⅱ(57)and Ⅲ (37)and located in L_3-4(10),L_4-5(94)and L₅-S₁(30).The operative time,blood loss,postoperative drainage,low back visual analogue scores(VAS),Oswestry disability index (ODI),intervertebral bone fusion rate and postoperative complications were recorded and compared between the 2 groups.Results:The operative time,blood loss and postoperative drainage of one-cage group were less compared to two-cage group(90.0+/-25.0 vs 115.0+/-35.0 min,t=-4.797,P=0.000; 210.0+/-100.0 vs 320.0+/-120.0 ml,t=- 5.786,P=0.000; 80.0+/-50.0 vs 130.0+/-45.0 ml,t=-6.054,P=0.000).Six months after surgery,71 patients in one- cage group and 63 patients in two-cage group got intervertebral bone fusion.There were no statistical differences in the intervertebral bone fusion rate between the two groups(P=1.000).Four weeks after surgery,the low back VAS of all patients in the two groups decreased(8.0+/-1.3 vs 2.3+/-0.8 points,t=31.465,P=0.000; 8.1+/-1.1 vs 2.2+/-1.0 points,t=31.501,P=0.000).There were no statistical differences in the decreased VAS between the two groups(5.7+/-1.2 vs 5.9+/-1.3 points,t=-0.926,P=0.356).Four weeks after surgery,the lumbar vertebrae ODI of all patients in the two groups decreased(35.0+/-4.5 vs 8.1+/-1.4 points,t=48.096,P=0.000; 34.5+/-4.3 vs 8.0+/-1.1 points,t=47.390,P=0.000).There were no statistical differences in the decreased ODI between the two groups(26.9+/-4.8 vs 26.5+/-3.9 points,t=0.525,P=0.600).No loosening and breakage of the internal fixators were found in both of the 2 groups.The cerebrospinal fluid leakage(1 patient)was found in one-cage group,while cerebrospinal fluid leakage(7 patients)and infection(5 patients)were found in two-cage group.The complication rate of one-cage group was lower than that of two-cage group (χ²=11.856,P=0.001).Conclusion:There is no significant difference in lumbar pain relief,lumbar function improvement and intervertebral bone fusion rate increase between one cage and two cages in interbody fusion combined with pedicle screw internal fixation for treatment of Meyerding typesⅠ,Ⅱand Ⅲ lumbar spondylolisthesis,however,interbody fusion with one cage combined with pedicle screw internal fixation is an ideal method for treatment of lumbar spondylolisthesis for short operative time,less blood loss and less complications,so it is worthy of popularizing in clinic.

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更新日期/Last Update: 2014-10-30