摘要
目的：评价使用自体颗粒骨行椎间植骨融合联合椎弓根螺钉同定治疗腰椎问盘突出症合并节段不稳的临床疗效。方法：本组117例，男68例，女49例，年龄42～70岁，平均47．8岁。突出及失稳节段：L3／44例，L4／547例，L5／S161例，双节段（L4／5和L5／S1）5例。采用JOA评定标准判定术后疗效，观察术后失稳椎间有无移位，椎间植骨融合情况。结果：手术时间1．5～3h，平均1．9h；出血量300～900ml，平均410ml。并发硬膜囊撕裂2例，伤口感染1例。随访18个月～3年2个月，平均26个月，术后腰椎序列恢复正常；JOA评分术前平均（17．25±1．16）分，术后平均（25．68±1．37）分，两者有统计学差异（P〈0．01）；优良率95．7％。术后12个月椎间植骨融合率100％，未见断钉、断棒，退钉现象。结论：使用自体颗粒骨行椎间植骨联合椎弓根螺钉同定足治疗腰椎间盘突出症合并腰椎失稳比较可靠方法，临床疗效满意。
Objective：To evaluale the efficacy of Treatment of lumbar disc herniation and lumbar instability with Posterior inter-body morselized bone grafting in vertebrae for spinal fusion combined with short-segment pedicle instrumentation. Methods： 117 cases with lumbar disc herniation and lumbar instability were studied.Among these cases,there were 68males and 49 females,with the average age of 47.8 years-old （rang,42-70 years old）,definite herniation and instability was determined at L3/4 in 4 cases,L4/5 in 47 cases,L5/S 1 in 61 cases,L4/5 and L5/S1 in 5 cases.JOA criterion was used to determine postoperative clinical effect.The ratio of fusion and their adjacent craninal space wese observed. Result： The operating time was 1.5-3 hours （average, 1.9 hours）,with blood loss approximately of 300-900ml （average,410ml）.2 cases had dural tear and 1 case got infected.All patients wese follow-up for 18-38 months （average,26 months）.The lumbar spine alignment returned to normal after operation.The JOA score was （ 17.25 ±1.16） pemperative and （25.68 ± 1.37）at final follow-up.There was significant difference between them （P 〈 0.01 ）.All cases obtained fusion at 12 months after operation,with the excellent and good rate of 95.7% and no recurrence of instrument failure at final follow-up. Conclusion：Posterior inter-body morselized bone grafting in vertebrae for spinal fusion combined with short-segment pedicle instrumentation for lumbar disc herniation and lumbar instability is a safe and reliable.
关键词
颗粒骨
椎间盘
椎间融合
椎弓根螺钉
Morselized bone
Lumbar disc
lnterbedy fusion
Pedicle screw
