Effect of 270° autogenous bone replantation around the intervertebral cage on vertebral fusion rate and efficacy after lumbar fusion
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摘要:
目的 探讨椎间隙内环Cage周围270°自体骨回植术对行腰椎融合术患者的疗效及椎体融合率情况的影响。 方法 选取2017年6月—2019年12月在阜阳市人民医院行腰椎后路减压椎弓根螺钉内固定椎间Cage置入融合的腰椎管狭窄症患者共64例作为研究对象。按随机数字表法将患者分为对照组和观察组,每组32例。观察组椎间隙融合采用环Cage周围270°自体骨植骨,对照组融合采用椎间隙前缘植骨结合填充自体骨的Cage。2组病例分别于术后拔除引流管复查X线,术后12个月复查腰椎动力位片及CT,通过Suk法及Siepe法对比2组患者椎间融合率、椎间隙高度变化,评估不同椎间融合方式下腰椎椎间融合的效果以及患者的临床疗效。 结果 术后患者随访12~18个月,术后1周、12个月复查,术后12个月见观察组融合率高于对照组,差异有统计学意义(均P < 0.05);术后1周、术后1年椎间隙高度及椎间孔高度均较术前有明显改善,差异有统计学意义(均P < 0.05)。 结论 通过对比提示椎间隙内环Cage周围270°自体骨回植术,比单纯椎间Cage植入植骨融合率高,因此建议Cage植入前后在椎间隙内植入同种自体骨将Cage包裹,更有利于椎间隙的融合。 Abstract:Objective To investigate the effect of 270° autologous bone replantation around the cage of the intervertebral space on the efficacy of lumbar fusion and the fusion rate of the vertebral body. Methods A total of 64 patients with lumbar spinal stenosis who underwent posterior decompression of the lumbar spine and pedicle screw internal fixation with interbody cage placement and fusion in our hospital from June 2017 to December 2019 were selected as the research objects. According to the random number table method, the patients were divided into control group and observation group, with 32 cases each group. The observation group was given 270° autogenous bone graft around the ring cage, whilst the control group was given anterior edge bone graft of the intervertebral space combined with the cage filled with autogenous bone. After the drainage tube was removed, the two groups of patients were re-examined by X-ray, and the lumbar dynamics and CT were re-examined 12 months after the operation. The Suk and Siepe methods were used to compare the intervertebral fusion rate and the change of intervertebral space height in both groups to evaluate different vertebrae, the effect of lumbar intervertebral fusion and the clinical curative effect of patients under the interfusion mode. Results The patients were followed up for 12 to 18 months, and re-examinations were performed at 1 week and 12 months after the operation. The fusion rate in the observation group was higher than that in the control group at 12 months after the operation. The height of the intervertebral space and the height of the intervertebral foramen were significantly improved at 1 week and 1 year after the operation, and the difference was statistically significant (all P < 0.05). Conclusion The comparison suggests that the 270° autologous bone replantation around the cage in the intervertebral space has a higher fusion rate than the simple intervertebral cage implantation. Therefore, the same kind of autologous bone should be implanted in the intervertebral space before and after the cage implantation, which is more conducive to the fusion of the intervertebral space. -
Key words:
- Lumbar fusion /
- Cage surrounding graft /
- Lumbar spinal stenosis
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表 1 2组腰椎管狭窄症患者一般资料及围手术指标比较
组别 例数 性别(例) 年龄(x±s,岁) 手术时间(x±s,min) 手术出血量(x±s,mL) 术后24 h引流量(x±s,mL) 住院时间(x±s,d) 男性 女性 对照组 32 20 12 53.3±7.3 119.2±23.2 250.3±98.6 125.6±45.8 6.7±1.7 观察组 32 24 8 51.5±7.7 123.1±15.7 275.0±80.7 132.5±45.5 7.3±1.5 统计量 1.164a 0.944b -0.788b -1.096b -0.602b -1.654b P值 0.419 0.349 0.434 0.277 0.549 0.103 注:a为χ2值,b为t值。 表 2 2组腰椎管狭窄症患者疗效指标比较(x±s, 分)
组别 例数 术前VAS腿痛评分 术后1周VAS腿痛评分 术前ODI评分 术后1年ODI评分 对照组 32 6.3±1.4 1.8±0.8a 46.7±6.1 11.1±1.8a 观察组 32 6.8±1.3 1.7±0.8a 44.2±4.9 10.2±2.1a t值 -1.346 0.471 1.818 1.786 P值 0.183 0.639 0.074 0.079 注:与术前比较,aP<0.05。 表 3 2组腰椎管狭窄症患者椎间隙高度及椎间孔高度比较(x±s,mm)
组别 例数 椎间隙高度 椎间孔高度 术前 术后1周 术后1年 术前 术后1周 术后1年 对照组 32 7.36±0.67 11.45±0.45a 10.76±0.39ab 17.54±0.99 22.50±0.80a 21.42±0.79ab 观察组 32 7.50±0.61 11.62±0.34a 10.63±0.35ab 17.35±0.80 22.76±0.86a 21.74±0.95ab F值 0.850 2.662 1.997 0.715 1.541 2.078 P值 0.360 0.108 0.163 0.401 0.219 0.154 注:与术前比较,aP<0.05;与术后1周比较,bP>0.05。 表 4 2组腰椎管狭窄症患者融合率比较(例)
组别 例数 融合率(Suk法) 融合率(Siepe法) 融合 可疑融合 不融合 融合 不融合 对照组 32 21 8 3 24 8 观察组 32 29 3 0 31 1 χ2值 6.553 6.335 P值 0.038 0.026 注:a为使用Fisher精确检验。 -
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