CAJ | 학술논문

背景：目前国内外公认椎体间融合术（PLIF）是治疗腰椎滑脱症的最佳手术方式，但椎间融合器的应用尚存争议。目的：比较同一患者应用自体骨植骨和椎间融合器行PLIF治疗不同节段腰椎滑脱症的临床疗效。 　　方法：2008年3月至2012年1月收治两节段腰椎滑脱症患者61例，两个病变节段分别应用自体骨植骨和椎间融合器行腰椎后路PLIF。术前、术后和随访期间的日本骨科学会（JOA）下腰痛功能评分、Oswestry功能障碍指数（ODI）、视觉模拟评分（VAS）进行临床疗效评估；Tailland指数、Boxal指数、滑脱角、腰椎生理前凸角进行影像学疗效评估；Suk法进行椎间融合评估；测量比较各节段的椎间隙及椎间孔高度。 　　结果：全部获得随访，随访时间为11~47个月，平均28.4个月。JOA评分治疗改善优良率为91.8%，术后JOA评分、ODI、VAS、Tailland指数、Boxal指数、滑脱角、腰椎生理前凸角均较术前明显好转（P＜0.01），且末次随访无丢失（P＞0.05）。应用自体骨植骨的融合时间为（8.8±3.4）个月，融合率为93.4%；应用椎间融合器的融合时间为（9.4±2.9）个月，融合率为95.1%，两种椎间融合方式的融合时间及融合率相比较均无统计学差异（P＞0.05）。术后各腰椎间隙前缘高度、后缘高度、平均高度及椎间孔高度均较术前明显提高（P＜0.01），但两种椎间融合方式术前和术后的腰椎间隙前缘高度、后缘高度、平均高度及椎间孔高度相比较无统计学差异（P＞0.05）。自体骨植骨椎间融合方式末次随访的椎间隙前缘高度、平均高度及椎间孔高度与术后比较丢失明显（P＜0.05）。 　　结论：两种椎间融合方式均获得良好的临床疗效及椎间融合，而椎间融合器在维持椎间高度方面表现优异，其联合前方自体骨植骨可以作为PLIF的理想椎间融合选择。揹景：目前國內外公認椎體間融閤術（PLIF）是治療腰椎滑脫癥的最佳手術方式，但椎間融閤器的應用尚存爭議。目的：比較同一患者應用自體骨植骨和椎間融閤器行PLIF治療不同節段腰椎滑脫癥的臨床療效。 　　方法：2008年3月至2012年1月收治兩節段腰椎滑脫癥患者61例，兩箇病變節段分彆應用自體骨植骨和椎間融閤器行腰椎後路PLIF。術前、術後和隨訪期間的日本骨科學會（JOA）下腰痛功能評分、Oswestry功能障礙指數（ODI）、視覺模擬評分（VAS）進行臨床療效評估；Tailland指數、Boxal指數、滑脫角、腰椎生理前凸角進行影像學療效評估；Suk法進行椎間融閤評估；測量比較各節段的椎間隙及椎間孔高度。 　　結果：全部穫得隨訪，隨訪時間為11~47箇月，平均28.4箇月。JOA評分治療改善優良率為91.8%，術後JOA評分、ODI、VAS、Tailland指數、Boxal指數、滑脫角、腰椎生理前凸角均較術前明顯好轉（P＜0.01），且末次隨訪無丟失（P＞0.05）。應用自體骨植骨的融閤時間為（8.8±3.4）箇月，融閤率為93.4%；應用椎間融閤器的融閤時間為（9.4±2.9）箇月，融閤率為95.1%，兩種椎間融閤方式的融閤時間及融閤率相比較均無統計學差異（P＞0.05）。術後各腰椎間隙前緣高度、後緣高度、平均高度及椎間孔高度均較術前明顯提高（P＜0.01），但兩種椎間融閤方式術前和術後的腰椎間隙前緣高度、後緣高度、平均高度及椎間孔高度相比較無統計學差異（P＞0.05）。自體骨植骨椎間融閤方式末次隨訪的椎間隙前緣高度、平均高度及椎間孔高度與術後比較丟失明顯（P＜0.05）。 　　結論：兩種椎間融閤方式均穫得良好的臨床療效及椎間融閤，而椎間融閤器在維持椎間高度方麵錶現優異，其聯閤前方自體骨植骨可以作為PLIF的理想椎間融閤選擇。
배경：목전국내외공인추체간융합술（PLIF）시치료요추활탈증적최가수술방식，단추간융합기적응용상존쟁의。목적：비교동일환자응용자체골식골화추간융합기행PLIF치료불동절단요추활탈증적림상료효。 　　방법：2008년3월지2012년1월수치량절단요추활탈증환자61례，량개병변절단분별응용자체골식골화추간융합기행요추후로PLIF。술전、술후화수방기간적일본골과학회（JOA）하요통공능평분、Oswestry공능장애지수（ODI）、시각모의평분（VAS）진행림상료효평고；Tailland지수、Boxal지수、활탈각、요추생리전철각진행영상학료효평고；Suk법진행추간융합평고；측량비교각절단적추간극급추간공고도。 　　결과：전부획득수방，수방시간위11~47개월，평균28.4개월。JOA평분치료개선우량솔위91.8%，술후JOA평분、ODI、VAS、Tailland지수、Boxal지수、활탈각、요추생리전철각균교술전명현호전（P＜0.01），차말차수방무주실（P＞0.05）。응용자체골식골적융합시간위（8.8±3.4）개월，융합솔위93.4%；응용추간융합기적융합시간위（9.4±2.9）개월，융합솔위95.1%，량충추간융합방식적융합시간급융합솔상비교균무통계학차이（P＞0.05）。술후각요추간극전연고도、후연고도、평균고도급추간공고도균교술전명현제고（P＜0.01），단량충추간융합방식술전화술후적요추간극전연고도、후연고도、평균고도급추간공고도상비교무통계학차이（P＞0.05）。자체골식골추간융합방식말차수방적추간극전연고도、평균고도급추간공고도여술후비교주실명현（P＜0.05）。 　　결론：량충추간융합방식균획득량호적림상료효급추간융합，이추간융합기재유지추간고도방면표현우이，기연합전방자체골식골가이작위PLIF적이상추간융합선택。
Background:It has been generally acknowledged that Lumbar Interbody Fusion (LIF) is the most effective therapy for lum-bar spondylolisthesis, but the use of interbody fusion cage remains controversial. Objective:To compare the clinical efficacy of autogenous bone grafting and interbody fusion cage in treating different seg-ments of lumbar spondylolisthesis on the same case. Methods:From March 2008 to January 2012, 61 patients with two-segments lumbar spondylolisthesis were treated in our hospital. These two segments were treated respectively with autogenous bone grafting and interbody fusion cage by posteri-or lumbar interbody fusion. At the preoperative, postoperative and follow-up stage respectively, the Japanese Orthopaedic Association (JOA) scores of the lower back pain, Oswestry Disability Index (ODI), and Visual Analogue Scale (VAS) were recorded for clinical evaluation;the Tailland indexes, Boxal indexes, slipping angles, and lumbar lordosis angles were re-corded for radiographic evaluation; the Suk standard was adopted for efficacy evaluation; and the height of intervertebral space and foramen of segments were measured and compared. Results:All the 61 cases were followed up, the mean follow-up period was 28.4 (11-47) months. The excellent and good rate of the JOA improvement was 91.8%. The JOA scores of the lower back pain, ODI, VAS, Tailland indexes, Boxal index-es, slipping angles, and lumbar lordosis angles at the postoperative stage were all significantly improved compared to the preoperative stage (P<0.01), and there was no loss of the scores at the last follow-up (P>0.05). The fusion time of the fora-men of the autogenous bone grafting was (8.8 ± 3.4) months, the fusion rate was 93.4%, and the fusion time of the foramen of interbody fusion cage was (9.4±2.9) months, and the union rate was 95.1%. There was no statistical difference between ei-ther fusion time or rate of the two methods (P>0.05). Lumbar intervertebral height of anterior border, that of posterior bor-der, average height of intervertebral space and height of foramen segments were significantly increased after the surgery (P<0.01), but there was no statistical difference in these heights between the 2 methods (P>0.05). Compared to the postop-erative data, the above data were significantly decreased at the last follow-up (P<0.05). Conclusions:Both methods of lumbar interbody fusion obtained satisfactory clinical efficacy and lumbar fusion, while the cage is better in sustainning heights of intervertebral space. To sum up, cage with anterior autogenous bone grafting is excel-lent for interbody fusion in PLIF.