椎弓根螺钉置入内固定联合自体颗粒骨移植治疗退行性腰椎病变

背景：植骨材料来源、形态及植骨方式对腰椎融合的影响目前仍有争议。自体颗粒骨打压植骨作为一种新的植骨方式，具一定的优点，但目前在腰椎融合的临床应用报道不多。 目的：探讨后路椎弓根螺钉置入内固定联合自体颗粒骨打压移植治疗退行性腰椎疾患的临床可行性。 方法：纳入接受后路腰椎融合治疗的退行性腰椎疾病患者21例(28个节段)，其中腰椎间盘突出合并节段性不稳定7例，腰椎间盘突出合并椎管狭窄6例，退变性腰椎不稳8例。对21例(28个节段)退行性腰椎疾病患者行后路自体颗粒骨打压植骨联合椎弓根螺钉置入内固定治疗。根据植骨前后X射线片评价植骨融合率，采用腰腿痛VAS目测评分法、ODI评分法及标准Macnab疗效评价临床症状改善情况。 结果与结论: 全部患者随访12个月以上，3~5个月后可见骨融合征象，无高度及复位丢失、螺钉断裂等现象，患者腰腿痛等症状均有不同程度缓解。末次随访VAS目测类比评分、ODI评分均较术前明显改善(P < 0.01)，脊柱融合率为95%。1例患者术后6 d CT检查示椎管内小骨粒压迫神经；1例术后第5天出院后伤口浅表软组织感染。采用Macnab标准评价临床结果：优10例，良9例，差2例，优良率91%。说明后路自体颗粒骨打压移植联合椎弓根螺钉置入内固定治疗退行性腰椎疾患短期临床效果良好，植骨融合率高，手术并发症少。 关键词: 自体颗粒骨； 打压植骨； 椎体间融合；椎弓根螺钉；内固定；硬组织植入物

Pedicle screw fixation with autogenous morselized bone graft impaction for senile lumbar degeneration

BACKGROUND: It remains controversial about the source and shape of bone material, as well as the pattern of bone-grafting. As a new method, autogenous morselized bone graft impaction has some advantages, but there are few reports about the clinical application in lumbar interbody fusion. OBJECTIVE: To investigate the feasibility of pedicle screw fixation with autogenous morselized bone graft impaction in the posterior lumbar interbody fusion for senile lumbar degeneration. METHODS: A total of 21 senile lumbar degeneration cases (28 segments) underwent autogenous morselized bone graft impaction in the posterior lumbar interbody fusion, including 7 of lumbar disc herniation combined with segmental instability, 6 of lumbar spinal stenosis, and 8 of degenerative lumbar instability. Pedicle screw fixation with autogenous morselized bone graft impaction was performed in all patients. The fusion rate was evaluated according to the pre and post operative X-ray. The clinical outcomes were measured according to VAS scores, ODI scores as well as Macnab evaluation scale. RESULTS AND CONCLUSION: All patients were followed up for more than 12 months. The bony fusions were detected in 3-5 months postoperatively. No reduction or fixation failure was found. After operation, the lower back pain and leg pain was relieved in different levels. The VAS and ODI scores at the final follow up were significantly improved compared with preoperative scores (P < 0.01), and the fusion rate was 95%. There was 1 case whose CT scanning showed some morselized bone in the spinal canal on day 6 after operation, causing the nerve compressed, and 1 case whose soft tissue of the cut was infected post-discharge on day 5 after operation. The Macnab criteria revealed that 10 patients had excellent result, 9 had good, 0 had fair, and 2 had bad, with a excellent and good rate of 91%. Results show a good short-term clinical outcome of pedicle screw fixation with autogenous morselized bone graft impaction applying in posterior lumbar interbody fusion for senile lumbar degeneration with high interbody fusion rate and low complication rate.