Cage和自体骨椎间植骨并椎弓根固定治疗腰椎滑脱临床分析.pdf

目 录 中文摘要 ················································1 英文摘要 ················································3 引 言 ················································6 正 文 ················································7 1.病例材料 ·············································7 1.1 病例纳入标准及排除标准 ···························7 1.2 手术方法 ·············································8 1.2 术后评价 ·············································9 2.治疗结果 ············································10 2.1 附表 ···············································12 3.讨 论 ·············································15 结 论 ···············································21 参考文献 ··············································23 附 图 ···············································25 综 述 ···············································29 致 谢 ···············································42 攻读学位期间发表的学术论文目录 ····················43 作者声明 ··············································44 个人简历 ··············································45 . 中 文 摘 要 目 的：比较椎间融合器植骨、椎体间自体骨植骨两种植骨方式附加椎 弓根螺钉系统治疗腰椎滑脱的临床疗效。 方 法：通过观察45例腰椎滑脱症患者的不同植骨方法手术治疗效果， 其中单枚Cage椎间融合器加椎弓根螺钉系统固定组（A组，共25例），椎 体间植骨加椎弓根螺钉系统固定组（B组，共20例）,患者的术前、术后 即刻和随访8月时的JOA评分,Taillard指数,复位好转率（Ris评分）、平均 椎间隙高度、植骨融合率等指标的评估，比较不同植骨方法的疗效。 结 果：两组的年龄、术前的滑脱分度及术前的JOA 评分均具 有可比性。A、B组术后随访8月的JOA评分分别为21.96 ±3.23、23.05 ±2.52分，P值比较差异不存在显著性（p0.05 ）；A、B组病例术后即刻的 影像学结果平均椎间隙高度分别为10.21 ±0.32mm、10.0 ±0.60mm，两组P 值比较差异不存在显著性（p0.05 ）；至随访8月时分别为8.76 ±0.31mm、 8.51 ±0.33mm，A组在平均椎间隙高度丢失方面要少于B组，但两组P值比较 差异无显著性（p0.05 ）。在滑脱复位（Taillard 指数）方面，A、B组病人 术后即刻的Taillard指数分别为8.04 ±1.87%、8.43±2.36%，术后随访8月时 分别为8.23 ±2.36%、8.52 ±2.29%，两组间术后即刻的Taillard指数P值比较 无显著性差异 （p0.05 ），而随访8月时两组病人的Taillard指数较术后即刻 均有所丢失,A组丢失少于B组，两组间比较差异不存在显著性（p0.05）。 在植骨融合率方面，到随访8月时A组23例融合，2例未融合，融合率92%，B 组18例融合，2例未融合,融合率90%治疗组与对照组在融合率方面P值比较 差异无显著性 （p0.05 ）。 结 论：1： Cage椎间植骨和椎间自体植