黄国文, 尚显文

(1.贵州省第二人民医院 急诊科， 贵州 贵阳　550004； 2.贵州医科大学附院 骨科， 贵州 贵阳　550004)



3种植骨方式对腰椎内固定术疗效的影响

黄国文1, 尚显文2

(1.贵州省第二人民医院 急诊科， 贵州 贵阳550004； 2.贵州医科大学附院 骨科， 贵州 贵阳550004)

目的： 观察3种植骨方式对腰椎内固定术疗效的影响。方法: 271例行腰椎植骨融合内固定术的腰椎疾病患者，根据植骨方式分为后外侧植骨组84例、椎间植骨组96例、360°植骨91例，所有患者于术后2、3、6月、1年及2年常规行X线摄片检查，比较3种术式的有效病例；比较术后2年，3种术式的失效例数及比例。结果: 术后2月和3月时，3种植骨术式的有效率高达95%以上，两两比较，差异无统计学意义(P>0.05)；从术后6月开始，后外侧植骨的有效率低于椎间植骨和360°植骨，术后2年时后外侧植骨有效率<90%，而椎间植骨和360°植骨仍>95%，差异有统计学意义(P<0.05)；椎间植骨与360°植骨疗效比较，差异无统计学意义(P>0.05)；术后2年时，后外侧植骨9例、椎间植骨3例及360°植骨2例患者发生内固定发生钉棒系统松动、断裂，失效率分别为10.07%、3.1%级2.2%，差异有统计学意义(P<0.05)。结论： 椎间植骨术及360°植骨术的腰椎内固定疗效优于后外侧植骨。

腰椎; 内固定； 外科手术； 植骨方式

[Abstract]Objective: To investigate the effect of three ways of bone graft for lumbar internal fixation. Methods： 271 patients with lumbar interbody fusion and internal fixation were divided into three groups according to mode of bone graft, 84 cases in group posterior lateral bone graft, 96 cases in bone graft intervertebral and 91 cases in 360 degree bone graft. The patients were examined with conventional radiography in second months, third months, sixth months, the first year and the second year. To compare the effective cases of three different bone graft methods and to compare the number and proportion of failure cases in second year of surgery. Results: The differences of the effective rate of the 3 implants was more than 95% at second and third months after operation, there was no statistical significance (P>0.05). After sixth months, the effective rate of the posterior lateral bone graft was lower than that of the bone graft intervertebral and 360 degree bone graft. At second years after operation, the efficiency of the posterior lateral bone graft was less than 90%, while the intervertebral bone graft and the 360 degree bone graft were still higher than 95%, the difference was statistically significant (P<0.05). There was no significant difference in the curative effect between the bone graft intervertebral and the 360 degrees bone graft (P>0.05). Loosening and fracture occurred in the spinal fixation system were to be found 9 cases of posterior lateral bone graft, 3 cases of intervertebral bone graft and 360 degrees of bone graft were 2 cases. Loss of efficiency was 10.7%, 3.1%, 2.2%, the difference was statistically significant (P<0.05). Conclusion: The therapeutic effect of internal fixation with intervertebral bone grafting and 360 degree bone grafting is better than that of posterior lateral bone graft.

[Key words]lumbar vertebra; internal fixation; surgical procedures,operative; bone graft

腰椎疾病是骨科常见疾病之一，常合并脊髓和神经根损伤，90%以上患者需要开放手术和内固定治疗[1]。腰椎植骨融合内固定术是解决腰椎不稳的重要手段，可消除邻近腰椎的节段病理性活动，融合治疗可重建脊柱稳定性，被广泛应用于腰椎畸形、骨折、脱位，滑脱及椎间盘等疾病的治疗[2]。对于选择何种术式重建脊柱的稳定性，减少内固定失效，仍存在较大争议，目前可采用的植骨方式为椎间植骨、后外侧植骨和360°植骨，本研究对3种植骨方式的疗效进行观察。