单节段TLIF术中椎间Cage与自体颗粒骨移植效果比较

目的比较单节段经椎间孔腰椎间融合术（TLIF）手术中椎间Cage与自体颗粒骨植骨对椎间孔高度的影响,及其治疗退变性腰椎管狭窄症临床效果。方法因患退变性腰椎管狭窄症拟行单节段TLIF手术病人91例,随机分为两组,Cage组47例,行TLIF＋单枚Cage椎间植入;植骨组44例,行TLIF＋自体颗粒骨椎间打压植骨。分别于术前、术后1周及术后2年随访,测量椎间孔高度,评估疼痛视觉模拟评分（VAS评分）和日本骨科协会评估治疗分数（JOA评分）;末次随访统计植骨融合率、手术有效率及并发症发生率。结果术后2年Cage组椎间孔高度大于植骨组,差异有显著性（t=9.22,P〈0.05）;两组间术前、术后1周及术后2年JOA、VAS评分差异无显著性（P〉0.05）,手术有效率、植骨融合率及并发症发生率差异无显著性（P〉0.05）。结论单节段TLIF术中椎间Cage植入对椎间孔高度恢复效果优于自体颗粒骨移植,两种手术方式治疗退变性腰椎管狭窄症的临床效果无显著差异。

INTERVERTEBRAL CAGE IMPLANTATION VERSUS MORSELIZED AUTOGRAFTS IN SINGLE SEGMENT TLIF

Objective To compare the influence of intervertebral Cage implantation versus morselized outografts on the height of intervertebral foramen in trans-foraminal lumbar interbody fusion（TLIF）and the efficacy for degenerative lumbar spinal stenosis（DLSS）. Methods Ninety-one patients with DLSS scheduled to undergo a single-segment TLIF surgery were randomized to two groups as Cage group（n=47）-TLIF plus one Cage intervertebral implantation;bone graft group（n=44）-TLIF plus autogenous morselized bone impacted intervertebral grafts.The patients were followed before surgery and one week and two years after surgery to measure the height of the intervertebral foramen,to evaluate Japanese Orthopaedic Association Score（JOA）and Visual Analogue Scale（VAS）.Bone graft fusion rates,operation efficiencies and complications were recorded at the last follow-up.Results Two years after surgery,the intervertebral foramen in the Cage group was higher than that in the bone graft group,the difference was significant（t=9.22,P〈0.05）.The differences between the two groups were not significant in terms of JOA and VAS before surgery and one week and two years postoperatively,as well as the efficacy,fusion rates and complications（P〉0.05）.Conclusion Cage implantation for intervertebral foramen height restoration is better than autogenous particulate bone,while the clinical effectiveness of the two surgical procedures is not significantly different for degenerative lumbar spinal stenosis.