腰椎后路椎体间植骨融合的疗效观察

目的探讨腰椎后路椎体间植骨融合的手术技术，观察疗效并评价其应用价值。方法对明确诊断下腰椎不稳的71例患者行后路双侧椎板间开窗减压，椎弓根螺钉固定，单侧切除椎间盘保留侧方及前方的纤维环，刮除终板的软骨层，植入足量的自体松质骨。术后不同随访时间观察症状改善及植骨融合情况。结果平均随访37．3个月（23～82个月），原有的神经压迫症状消失，术后疼痛VAS评分和Oswestry功能障碍指数改善率分别为（83．52±2．41％和（72．66±4．1）％。术后6～9个月移植骨间隙轮廓不清，CT示椎体与植骨块交界处无透亮区。11例（15．5％）患者融合不良，植骨块吸收，但症状改善。结论腰椎后路椎体间植骨融合术结合椎弓根固定符合腰椎的自然生物力学特征，即椎体的压力支撑原则以及后结构的张力带原则，是腰椎稳定性重建的理想植骨方法。

Long term clinical results of posterior lumbar interbody fusion

Objective To study the clinical results and surgical technique of the posterior lumbar interbody fusion. Methods A total of 71 patients with degenerative lumbar instability underwent posterior lumbar interbody fusion with autograft from unilateral side and open discectomy with pedicle screw instrumentation. All patients could ambulate 1 to 2 weeks post-operatively with brace which should be used for 3 months. Results The mean follow-up was 37.3 months, ranged from 23 to 82 months. Effective pain relief and functional improvement has been obtained, and the improved rate of VAS and ODI is （83.52±2.4）% and （72.66±4.1）% respectively. Solid bone union was observed 6 to 9 months post-operatively. Eleven patients showed nonunion but the symptoms improved. Conclusions Posterior lumbar interbody fusion with pedicle screw fixation is a sound method that accords with biomechanical features of the lumbar spine, and it is an ideal method to reconstruct the stability of the lumbar spine.