CAJ | 학술논문

目的：比较两种不同椎间植骨融合术治疗腰椎不稳的临床疗效及各自优缺点。方法回顾性分析自2012年6月至2013年6月采用两种不同的植骨方法治疗64例腰椎不稳患者的临床资料，按照患者意愿分为打压植骨组和椎间融合器植骨组。打压植骨组40例，男28例，女12例；平均年龄62岁。椎间融合器植骨组24例，男16例，女8例；平均年龄61岁。观察并比较两组手术术后椎间隙高度变化、日本骨科协会（Japanese orthopaedic association，JOA）评分、临床疗效优良率及植骨融合率等指标。结果术后患者均获随访，随访时间16～28个月，平均23个月。两组术后及末次随访时椎间隙高度与术前相比均有显著提高，差异有统计学意义（ P ＜0.05）；与术后即刻比较，椎间融合器植骨组显著高于打压植骨组，差异有统计学意义（P ＜0.05）。术前两组均行 JOA 评分比较，差异均无统计学意义（P ＞0.05）。末次随访时，各组 JOA 评分均较术前显著降低。术后1年复查 X 线片显示：椎间融合器植骨组植骨融合率均显著高于打压植骨组。结论椎弓根钉内固定结合椎间打压植骨融合与椎间融合器植骨融合治疗腰椎不稳，两种术式比较无明显临床疗效差异，可根据患者的具体情况选择相应术式。
목적：비교량충불동추간식골융합술치료요추불은적림상료효급각자우결점。방법회고성분석자2012년6월지2013년6월채용량충불동적식골방법치료64례요추불은환자적림상자료，안조환자의원분위타압식골조화추간융합기식골조。타압식골조40례，남28례，녀12례；평균년령62세。추간융합기식골조24례，남16례，녀8례；평균년령61세。관찰병비교량조수술술후추간극고도변화、일본골과협회（Japanese orthopaedic association，JOA）평분、림상료효우량솔급식골융합솔등지표。결과술후환자균획수방，수방시간16～28개월，평균23개월。량조술후급말차수방시추간극고도여술전상비균유현저제고，차이유통계학의의（ P ＜0.05）；여술후즉각비교，추간융합기식골조현저고우타압식골조，차이유통계학의의（P ＜0.05）。술전량조균행 JOA 평분비교，차이균무통계학의의（P ＞0.05）。말차수방시，각조 JOA 평분균교술전현저강저。술후1년복사 X 선편현시：추간융합기식골조식골융합솔균현저고우타압식골조。결론추궁근정내고정결합추간타압식골융합여추간융합기식골융합치료요추불은，량충술식비교무명현림상료효차이，가근거환자적구체정황선택상응술식。
Objective To investigate the clinical efficacy of the two different methods of interbody fusion for lumbar insta-bility and to compare their respective advantages and disadvantages. Methods From June 2012 to June 2013,64 patients with lumbar instability underwent pedicle screw fixation using two different bone grafts. Of 64 patients,40 received bone graft impac-tion with lumbar interbody fusion,and 24 received interbody fusion cage. Postoperative intervertebral height changes,JOA score,clinical curative rate and fusion rate index were recorded and compared. Results All patients were followed up,the fol-low-up time ranged from 16 to 28months,average 23 months The intervertebral space heights were significantly improved in 2 groups at immediately after operation and last follow-up compared with those before operation(P < 0. 05). Compared with the immediate postoperative,lumbar interbody fusion group was significantly less than the impaction bone grafting group,the differ-ence was statistically significant(P < 0. 05). There was no significant difference in JOA score in two groups before operation. (P > 0. 05). At the time of the last follow-up,both groups of JOA scores were decreased significantly. In one year after opera-tion,X-ray film showed that the fusion rate of the interbody fusion cage group was significantly higher than that of the impaction bone grafting group. Conclusion There is no significant difference in the clinical efficacy between bone graft impaction and bone graft impaction in the treatment of lumbar with pedicle screw fixation. In order to obtain better treatment effect,it is neces-sary to select appropriate method according to the specific condition of patients.