腰椎后路椎间植骨融合术的临床比较

目的：比较在腰椎后路椎间植骨融合术手术中是否使用椎弓根螺钉内固定的临床以及影像学结果。方法：本组病人都采用Cloward技术植入了自体髂骨，其中13例进行了椎弓根螺钉内固定，另21例未进行椎弓根螺钉内固定。两组病人的临床和影像学结果进行了比较。结果：固定组77％的病人获得优良疗效，非固定组为81％。固定组的融合率为76．9％，非固定组80．9％。两组中均未发现有植骨块的塌陷。固定组椎间隙高度平均减少了15．3％。非固定组椎间隙高度平均减少了18．4％。两组的临床和影像学结果没有统计学上的明显差异。结论：正确的手术，同时有足够数量和质量的髂骨骨块，可以承受正常生理载负荷，也可以达到很高的融合率。椎弓根系统螺丝钉内固定不必作为PLIF手术的常规以减少植骨块的下陷。

Posterior Lumbar Interbody Fusion:An Clinical Comparison Study

Objective: To compare the clinical result,graft subsidence and fracture with or without pedicle screw fixation during PLIF.Methods:This study was based on 34 consecutive patients who underwent PLIF with iliac crest bone graft.Thirteen patients had pedicle screw fixation and 21 patients were completed without pedicle screws.The radiographic and clinical results were compared between two groups.Results:The successful clinical results for the pedicle screw fixation group was 76.9% and 80.9% for the group without pedicle screw fixation.There was no graft collapse in either group.The average loss of disc space height for group with pedicle screw was 15.3% and 18.4% for group without pedicle screw.There was no statistically significant difference in clinical and radiographic results between two groups.Conclusion:There was no statistically significant difference in the clinical outcomes,graft subsidence or fracture between the groups with or without pedicle screw fixation.Properly performed PLIF constract with an adequate amount and quality of iliac crest bone graft can withstand normal physiological load and do provide a high rate of successful fusion.Pedicle screw fixation is not necessary for routine PLIF to prevent subsidence of bone graft.