CAJ | 학술논문

背景：对于骨质疏松性腰椎疾病患者，在实施后路腰椎间融合治疗时受骨密度等因素的影响会降低植骨融合率，但关于不同植骨材料及骨质疏松对后路腰椎间融合的影响，目前尚无全面的报道。 　　目的：分析不同植骨材料及骨质疏松对腰后路椎间植骨成功率的影响。 　　方法：回顾性分析227例行腰椎后路椎间融合治疗患者的临床资料，按照植骨材料的不同分为自体髂骨组(n=121)和融合器联合自体髂骨组(n=65)、同种异体骨组(n=41)，3组中骨质疏松患者分别有20，22，6例，治疗后随访24个月，对比3组植骨融合情况、融合时间、椎间高度变化及内固定失败等不良事件的发生情况。 　　结果与结论：同种异体骨组内固定失败率、植骨融合时间、椎间高度丢失高于自体髂骨组和融合器联合自体髂骨组(P <0.05)，植骨融合率低于自体髂骨组和融合器联合自体髂骨组(P<0.05)，自体髂骨组和融合器联合自体髂骨组各指标比较差异无显著性意义。在骨质疏松患者中，同种异体骨组内固定失败率、植骨融合时间高于自体髂骨组和融合器联合自体松质骨组(P<0.05)，椎间高度丢失及植骨融合率低于自体髂骨组和融合器联合自体髂骨组(P<0.05)；自体髂骨组融合时间短于融合器联合自体髂骨组(P<0.05)，融合率高于融合器联合自体髂骨组(P<0.05)。表明在后路腰椎椎间融合过程中，使用自体髂骨或融合器联合自体髂骨均可以获得较高的植骨融合率，内固定失败情况较少；对于合并骨质疏松患者，予以自体髂骨块植骨可以获得更好的融合效果。
배경：대우골질소송성요추질병환자，재실시후로요추간융합치료시수골밀도등인소적영향회강저식골융합솔，단관우불동식골재료급골질소송대후로요추간융합적영향，목전상무전면적보도。 　　목적：분석불동식골재료급골질소송대요후로추간식골성공솔적영향。 　　방법：회고성분석227례행요추후로추간융합치료환자적림상자료，안조식골재료적불동분위자체가골조(n=121)화융합기연합자체가골조(n=65)、동충이체골조(n=41)，3조중골질소송환자분별유20，22，6례，치료후수방24개월，대비3조식골융합정황、융합시간、추간고도변화급내고정실패등불량사건적발생정황。 　　결과여결론：동충이체골조내고정실패솔、식골융합시간、추간고도주실고우자체가골조화융합기연합자체가골조(P <0.05)，식골융합솔저우자체가골조화융합기연합자체가골조(P<0.05)，자체가골조화융합기연합자체가골조각지표비교차이무현저성의의。재골질소송환자중，동충이체골조내고정실패솔、식골융합시간고우자체가골조화융합기연합자체송질골조(P<0.05)，추간고도주실급식골융합솔저우자체가골조화융합기연합자체가골조(P<0.05)；자체가골조융합시간단우융합기연합자체가골조(P<0.05)，융합솔고우융합기연합자체가골조(P<0.05)。표명재후로요추추간융합과정중，사용자체가골혹융합기연합자체가골균가이획득교고적식골융합솔，내고정실패정황교소；대우합병골질소송환자，여이자체가골괴식골가이획득경호적융합효과。
BACKGROUND:For patients with osteoporosis, bone mineral density and other factors can lower the success rate of posterior lumbar interbody fusion. But there is no comprehensive report on the effects of different bone graft materials and osteoporosis on the posterior lumbar interbody fusion. OBJECTIVE:To explore the influence of different bone graft materials and osteoporosis on the success rate of posterior lumbar interbody fusion. METHODS:Clinical data of 227 patients undergoing posterior lumbar interbody fusion were retrospectively analyzed, and these patients were assigned into autogenous iliac bone group (n=121), fusion cage combined with autogenous cancelous bone group (combined group,n=65) and alograft group (n=41) according to different bone graft materials. There were 20, 22, 6 patients with osteoporosis in the three groups, respectively. Al the patients were folowed up for 24 months, and postoperative bone fusion, fusion time, intervertebral height and internal fixation failure and other adverse events were recorded and compared among three groups. RESULTS AND CONCLUSION:The failure rate of internal fixation, fusion time and loss of intervertebral height were higher, but the fusion rate was lower in the alograft group than the other two groups (P < 0.05). In addition, there was no difference between the autogenous iliac bone group and combined group. For the osteoporosis patients, the failure rate of internal fixation and fusion time were higher, while the loss of intervertebral height and fusion ratewere lower in the alograft group than the other two groups (P < 0.05); compared with the autogenous iliac bone group, the combined group had longer fusion time and higher fusion rate (P < 0.05). These findings indicate that autogenous iliac bone graft combined with or without fusion cage can achieve higher fusion rate and less internal fixation failure in the posterior lumbar interbody fusion; however, for osteoporosis patient, the autogenous iliac bone graft can obtain better fusion effects.