经椎间孔椎体间融合两种椎间骨移植的比较△

Comparison of two intervertebral bone grafting techniques in transforaminal lumbar interbody fusion

摘要:

［目的］ 探讨新型植骨管植骨在腰椎体间融合术中的安全性和有效性。［方法］ 回顾性分析 2018 年 9 月—2019 年 8 月经椎间孔椎体间融合术（transforaminal lumbar interbody fusion, TLIF）119 例患者的临床资料。依据医患沟通结果，61 例术中采用新型植骨管植骨，58 例采用传统漏斗植骨。比较两组围手术期、随访和影像资料。［结果］两组患者均顺利完成手术，术中均无神经、硬膜损伤。新型组植骨时间显著少于传统组（P<0.05）。两组手术时间、术中出血量、术后引流量及下地行走时间的差异均无统计学意义（P>0.05）。两组完全负重活动时间差异无统计学意义（P>0.05）。术后随访（22.94±2.28）个月，随时间推移，两组患者腰痛 VAS 和 ODI 评分显著下降（P<0.05），JOA 评分显著增加（P<0.05）。相应时间点，两组间上述指标的差异均无统计学意义（P>0.05）。影像方面，与术前相比，术后 1 个月和末次随访时两组患者椎间隙高度、局部 Cobb 角和 L2~S1前凸角均显著增加（P<0.05），随时间推移，两组 Lenke 椎间融合评级均显著改善（P<0.05）；术后 3 个月，新型组椎间融合 Lenke 评级显著优于传统组（P<0.05），但术后 6 个月和末次随访时，两组间 Lenke 椎间融合评级的差异已无统计学意义（P>0.05）。［结论］应用新型植骨管椎间植骨可以安全、高效地完成 TLIF 术，改善椎间融合。

Abstract:

[Objective] To investigate the safety and efficacy of a novel intervertebral bone grafting technique with a self-developed de- vice by comparison with the conventional technique in transforaminal lumbar interbody fusion (TLIF) for lumbar degenerative diseases. [Methods] A retrospective study was conducted on 119 patients who received TLIF for lumbar degenerative diseases from September 2018 to August 2019. According to doctor-patient communication, 61 patients had TLIF performed with the novel intervertebral bone grafting by a self-developed device (the NIBG group) , while the other 58 patients were with traditional intervertebral bone grafting (the TIBG group) . The perioperative, follow-up and imaging data were compared between the two groups. [Results] All patients in both groups had surgical procedures conducted successfully with no iatrogenic injuries to nerve roots or dura sac. The NIBG group had significantly less time spend for intervertebral bone grafting than the TIBG group (P＜0.05) , although there were no significant differences in operative time, intraopera- tive blood loss, postoperative drainage and postoperative walking time between the two groups (P＞0.05) . In addition, there was no signifi- cant difference in the time to resume full weight-bearing activity between the two groups (P＞0.05) . As time went during follow-up lasted for (22.94±2.28) months, the VAS and ODI scores decreased significantly (P＜0.05) , while JOA score increased significantly in both groups (P＜0.05) . At any corresponding time points, there was no a significant difference in the above items between the two groups (P＞0.05) . Ra- diographically, intervertebral height, local Cobb angle, and L2~S1 lordosis angle significantly increased in both groups at 1 month postopera- tively and the latest follow-up compared with those preoperatively (P＜0.05) . The Lenke scale for interbody fusion improved significantly over time in both groups (P＜0.05) , which in the NIBG group proved significantly superior to the TIBG group at 3 months postoperatively, whereas became not statistically significant between the two groups at 6 months and the latest follow-up (P＞0.05) . [Conclusion] This novel intervertebral bone grafting technique with the self-developed device does improve the safety, efficacy and interbody fusion of TLIF.