CAJ | 학술논문

目的比较单节段经椎间孔腰椎椎间融合术(TLIF)手术中椎间融合器植入或单纯自体颗粒骨植骨两种融合方式治疗退变性腰椎管狭窄症的临床疗效.方法 2010年1月至2011年6月青岛大学医学院附属医院黄岛分院骨科对87例拟接受单节段TLIF手术的退变性腰椎管狭窄症患者随机分为A、B两组;A组患者椎间隙内植入自体颗粒骨填塞的融合器1枚,B组椎间隙植入减压所得自体颗粒骨.记录所有患者手术时间、出血量、住院时间、住院费用.并在术前、术后1周,12、24个月定期随访,比较两组术后Oswestry功能障碍指数(ODI)、视觉模拟评分法评分(VAS)、手术并发症发生率、植骨融合率、椎间隙及椎间孔高度恢复、腰椎前凸角度改善的差别.结果围手术期内两组手术时间、术中出血量、出院时间差异无统计学意义,融合器组患者平均住院费用比自体骨组高18％ (P ＜0.05);两组患者两年内均获得良好的临床疗效,同期ODI、VAS评分差异无统计学意义(P＞0.05),手术并发症发生率差异无统计学意义(P＞0.05).术后2年融合器组融合率为86.7％,植骨组为85.7％,差异无统计学意义(P＞0.05);融合器组椎间隙高度、椎间孔高度的恢复优于植骨组,两组腰椎生理曲度改善差异无统计学意义.结论在椎弓根钉棒内固定基础上行单节段TLIF手术治疗退变性腰椎管狭窄症,椎间融合器植入及单纯自体颗粒骨植骨两种融合方式手术效果差异无统计学意义;融合器能更好的恢复椎间隙及椎间孔高度,单纯椎间自体颗粒骨植骨具有经济优势.
목적 비교단절단경추간공요추추간융합술(TLIF)수술중추간융합기식입혹단순자체과립골식골량충융합방식치료퇴변성요추관협착증적림상료효.방법 2010년1월지2011년6월청도대학의학원부속의원황도분원골과대87례의접수단절단TLIF수술적퇴변성요추관협착증환자수궤분위A、B량조;A조환자추간극내식입자체과립골전새적융합기1매,B조추간극식입감압소득자체과립골.기록소유환자수술시간、출혈량、주원시간、주원비용.병재술전、술후1주,12、24개월정기수방,비교량조술후Oswestry공능장애지수(ODI)、시각모의평분법평분(VAS)、수술병발증발생솔、식골융합솔、추간극급추간공고도회복、요추전철각도개선적차별.결과 위수술기내량조수술시간、술중출혈량、출원시간차이무통계학의의,융합기조환자평균주원비용비자체골조고18％ (P ＜0.05);량조환자량년내균획득량호적림상료효,동기ODI、VAS평분차이무통계학의의(P＞0.05),수술병발증발생솔차이무통계학의의(P＞0.05).술후2년융합기조융합솔위86.7％,식골조위85.7％,차이무통계학의의(P＞0.05);융합기조추간극고도、추간공고도적회복우우식골조,량조요추생리곡도개선차이무통계학의의.결론 재추궁근정봉내고정기출상행단절단TLIF수술치료퇴변성요추관협착증,추간융합기식입급단순자체과립골식골량충융합방식수술효과차이무통계학의의;융합기능경호적회복추간극급추간공고도,단순추간자체과립골식골구유경제우세.
Objective To compare the clinical efficacies of single segment transforaminal lumbar interbody fusion (TLIF) with cage versus autogenous morselized bone for degenerative lumbar spinal stenosis.Methods A total of 87 patients undergoing single segment TLIF were randomly divided into 2 groups.A cage was implanted into intervertebral space in group A patients while autogenous morselized bone in group B patients.Operative duration,blood loss,length of stay and cost of hospitalization of two groups were recorded.They were followed up at 1 week,12,24 months post-operation.Oswestry disability index (ODI),visual analogue scale (VAS) fusion rates,intervertebral space and foramen height restoration,lumbar lordosis and postoperative complications were compared between two groups.Results No significant inter-group difference existed in operative duration,blood loss or length of stay.However,the average hospitalization cost in group A were 18％ higher than that of group B (P ＜ 0.05).Both groups achieved excellent clinical outcomes within 2 years.ODI,VAS score improvement rates and postoperative complication rates were not statistically different.Lumbar fusion rate was 86.7％ in group A versus 85.7％ in group B after 2 years.And there was no significant difference (P ＞ 0.05).The heights of intervertebral space and foramen in group A achieved a better recovery than those of group B.Both groups had similar improvements of lumbar lordosis.Conclusion For degenerative lumbar spinal stenosis,usage of interbody cage is more effective in terms of recovery of intervertebral space and foraminal height compared with usage of bone graft.However it brings no better clinical efficacy while the usage of autogenous morselized bone is more cost-effective.Two grafting methods yield similar overall clinical outcomes.