CAJ | 학술논문

目的从增加骨移植物局部血供入手,建立一种带有原位椎旁肌肌骨瓣的新型腰椎后路植骨方法,观察其早期应用的植骨融合率,评估该方法的临床疗效.方法 2007年6月至2010年12月,应用新型植骨法对117例腰椎管狭窄和腰椎失稳的患者行腰椎管减压植骨融合内固定治疗,其中男性49例,女性68例,年龄40～77岁,平均61.5岁;所有患者术前及术后均进行日本骨科学会(JOA)及视觉模拟量表(VAS)评分,评价临床疗效,同时术后应用CT三维重建评价植骨融合效果.结果术后失访17例,其余病例随访7～38个月,平均19个月.术前JOA评分平均(10.3±1.9)分,末次随访时平均(25.4±4.2)分,与术前相比差异具有统计学意义(P＜0.01),改善率81.0％;术前下肢VAS评分为平均(8.5±0.8)分,术后为平均(2.3±0.4)分,术前、术后相比差异具有统计学意义(P＜0.01).术后CT三维重建显示,获得随访的100例患者的133个腰椎节段中,126个节段形成了坚固融合,融合率94.7％.结论新型腰椎后路植骨方法植骨位置确切、牢靠、融合率高,能够有效减少假关节的形成,疗效确切,具有良好的临床应用前景.
목적 종증가골이식물국부혈공입수,건립일충대유원위추방기기골판적신형요추후로식골방법,관찰기조기응용적식골융합솔,평고해방법적림상료효.방법 2007년6월지2010년12월,응용신형식골법대117례요추관협착화요추실은적환자행요추관감압식골융합내고정치료,기중남성49례,녀성68례,년령40～77세,평균61.5세;소유환자술전급술후균진행일본골과학회(JOA)급시각모의량표(VAS)평분,평개림상료효,동시술후응용CT삼유중건평개식골융합효과.결과 술후실방17례,기여병례수방7～38개월,평균19개월.술전JOA평분평균(10.3±1.9)분,말차수방시평균(25.4±4.2)분,여술전상비차이구유통계학의의(P＜0.01),개선솔81.0％;술전하지VAS평분위평균(8.5±0.8)분,술후위평균(2.3±0.4)분,술전、술후상비차이구유통계학의의(P＜0.01).술후CT삼유중건현시,획득수방적100례환자적133개요추절단중,126개절단형성료견고융합,융합솔94.7％.결론 신형요추후로식골방법식골위치학절、뢰고、융합솔고,능구유효감소가관절적형성,료효학절,구유량호적림상응용전경.
Objective To increase local blood supply of bone graft,a novel posterior lumbar spine fusion method with orthotopic paraspinal muscle-pediculated bone flaps was constructed,and the fusion rate and clinical effect.were observed.Methods From June 2007 to December 2010,117 patients of lumbar spinal stenosis or lumbar destabilization treated with the novel posterior lumbar fusion method were studied,49 males and 68 females,aged from 40 to 77 years,average 61.5 years.Clinical effect was evaluated by JOA and VAS score preoperatively and postoperatively,and the fusion result was evaluated by threedimensional CT reconstruction postoperatively.Results Seventeen cases lost of follow up,the rest were followed up from 7 to 38 months,average 19 months.There was significant difference between pre-and postoperative JOA and VAS score (P ＜0.01),the preoperative JOA score was 10.3 ± 1.9,and 25.4 ±4.2 at the latest follow-up,the improvement rate was 81.0％ ; the preoperative VAS score was 8.5 ±0.8,and 2.3 ± 0.4 at the latest follow-up.The three-dimensional CT reconstruction showed that 126 of the 133 segments formed solid fusion in 100 patients who completed the follow-up,the fusion rate was 94.7％.Conclusion The novel posterior lumbar fusion method make the bone graft position more precise,stable and increases the fusion rate,which can effectively reduce pseudarthrosis and have a promising clinical effect.