后路椎间盘摘除联合两种不同植骨融合椎弓根内固定治疗退变性腰椎间盘突出症疗效分析

目的：总结后路椎间盘摘除自体椎间植骨和横突间植骨融合椎弓根内固定两种手术方法治疗退变性椎间盘突出症的疗效。方法：对76例（122个腰椎节段）退变性椎间盘突出症患者行后路椎间盘摘除自体骨移植融合椎弓根内固定术，其中45例采用自体骨椎间植骨，31例采用自体骨横突间植骨，同时随访观察初期的临床疗效。结果：76例获随访，时间6~76个月，疗效评定应用Oswestry功能障碍指数（ODI）评定。椎间融合组优31例，良10例。优良率91.1%，横突间融合组优25例，良4例，优良率93.5%。骨融合率椎间融合组100%，横突间融合组96.8%。结论：后路椎间盘摘除自体椎间植骨和横突间植骨融合椎弓根内固定两种手术方法治疗退变性腰椎间盘突出症，临床疗效满意。在认真探讨和明确LDH腰腿痛的主导致病机制后，针对性采用不同融合方式。横突间融合组费用和并发症更少。

The Effectiveness of Posterior Discectomy in Combination of Two Different Types of Bone Fusion Transpedicular Internal Fixation in Treating Degenerative Lumbar Disc Herniation

Objective：To investigate effectiveness of two kinds of surgical treatments,posterior discectomy autologous intervertebral bone graft and intertransverse-bone graft on transpedicular internal fixation,on the degenerative disc herniation.Method：Among 76 patients（122 lumbar segment）with degenerative disc disease went through posterior discectomy under autogenous bone graft fusion pedicle screw fixation.Of which,45 patients were treated with autologous intervertebral bone graft and the rest were treated with autogenous intertransverse-bone graft.The initial clinical results were measured regularly.Result：The follow-up period was 6 to 76 months. Oswestry Disability Index（ODI）was applied to assess the treatment efficacy.In the intervertebral bone graft group,there were 31 excellent cases and 10 good cases,with good-excellent ratio at 91.1%. In the intertransverse-bone graft group,there were 25 excellent cases and 4 good cases,with good-excellent ratio at 93.5%.Bone fusion rate was 100%for the intervertebral bone graft group and 96.8%for intertransverse-bone graft group. Conclusion：The effectiveness of two kinds of surgical treatments,posterior discectomy autologous intervertebral bone graft and intertransverse-bone graft on transpedicular internal fixation,on the degenerative disc herniation is satisfactory. After carefully explored and clarified the dominant pathogenic mechanism of LDH low back pain,we selectively use different fusions.Intertransverse bone fusion has low operation costs and leads to fewer complications.