摘要
目的 探讨两种不同方式(横向和斜向)置入融合器对腰椎后路融合手术疗效、融合率和术后并发症的影响。方法 回顾性分析2016年3个月~2018年9月本院骨科开展的腰椎后路减压融合手术患者91例临床资料,术中均置入单枚子弹头形融合器:斜向组47例,术中常规斜向置入融合器;横向组44例,术中横向置入融合器。术后随访2年以上,对两组患者的疗效指标、影像学指标、融合指标和术后并发症等指标进行比较。结果 术后随访24~33个月,平均(27.6±2.8)个月。与术前相比,两组患者术后1周、术后3个月和末次随访的VAS评分、ODI指数均获显著改善(P<0.05),但组间差异无统计学意义(P>0.05)。横向组术后1周和末次随访时的植骨面积均显著大于斜向组(P<0.05)。横向组患者术后6个月时的植骨融合Brantigan评分和植骨融合率均显著高于斜向组,差异有统计学意义(P<0.05);术后1年和末次随访时,两组差异无统计学意义(P>0.05)。两组术后1周的椎间隙高度均显著高于术前(P<0.05);末次随访时,斜向组椎间隙高度有丢失现象(P<0.05),而横向组未见明显的椎间隙高度丢失。横向组融合器与椎间隙两侧边缘的距离相对均等,斜向组融合器与两侧椎间隙边缘的距离差异显著(P<0.05)。斜向组术后并发症的总发生率高于横向组,差异有统计学意义(2.27%vs 10.64%,P<0.05)。结论 横向或斜向置入融合器对腰椎减压融合手术的总体疗效并无影响,但横向融合器置入更有利于腰椎间融合、减少后期融合器下沉和钉棒断裂发生的风险。
Objective To investigate the effect of two different ways(transverse and oblique) of fusion cage placement on the surgical efficacy, fusion rate and postoperative complications in posterior lumbar decompression and fusion. Methods The clinical data of 91 patients who underwent posterior lumbar decompression and fusion in our hospital from March 2016 to September 2018 were retrospectively analyzed. All patients were implanted with single bullet shaped fusion cage. According to the placement method of fusion cage, they were divided into two groups: oblique group(47 cases) and transverse group(44 cases). The patients were followed up for more than 2 years, and the curative effect index, imaging index, fusion index and postoperative complications were compared between the two groups. Results The average follow-up time was(27.6±2.8)months. Compared with preoperation, the VAS score and ODI index of the two groups were significantly improved at 1 week, 3 months after operation and the last follow-up(P<0.05), there were no significant differences in the above indicators between the two groups(P>0.05). The bone graft area in the transverse group was significantly larger than that in the oblique group at 1 week after operation and the last follow-up(P<0.05). The Brantigan score and bone graft fusion rate of the transverse group at 6 months after operation were significantly higher than those of the oblique group(P<0.05);there was no significant difference between the two groups at 1 year after operation and the last follow-up(P>0.05). At the last follow-up, there was a loss of intervertebral space height in the oblique group(P<0.05), but there was no significant loss of intervertebral space height in the transverse group. In the transverse group, the distance between the fusion cage and the edge of bilateral intervertebral space was relatively equal, while in the oblique group, the distance between the fusion cage and the edge of bilateral intervertebral space was significantly different(P<0.05). The total incidence rate
作者
李中华
李增超
LI Zhong-hua;LI Zeng-chao(Department of Orthopedics,Weidaode Orthopedic Hospital,Zhumadian,Henan,463000,China)
出处
《颈腰痛杂志》
2022年第6期827-831,共5页
The Journal of Cervicodynia and Lumbodynia
关键词
腰椎融合手术
融合器
横向
斜向
植骨融合
lumbar fusion surgery
fusion cage
transverse
oblique
bone graft fusion
