| Objective:Explore autologous lamina joint cutting cylindrical in posterior vertebra fusion with pedicle screws system in the treatment of degeneratie lumbar disease on the clinical curative effect.Methods:From September 2008 to July 2010,82 inpatients with lower lumbar instability were randomized into two groups:interbody fusion Cage group A and the improved autologous spinal process fusion group B. In group A,44 inpatients were treated by PLIF using cage fusion,including 18 males and 26 females,aging 46-83 years,average age(60.7±10.5) years with 12-432 months of disease course,average 68 months. Vertebral I degrees 34 patients with narrow spondylolisthesis,Ⅱdegrees 10 cases with narrow spondylolisthesis.All of the patients have back pain or backleg pain,intermittent claudication 32 cases,sciatica 29 cases,muscle abate 21 cases.Surgery fusion segments:single segment fusion 28 cases, double section 16 cases, total fusion 60 segments.In group B,38 inpatients were treated by using improved autologous spinal process,including 21 males and 17 females,aging 44-79 years,average age(56.5±10.3) years with 12-480 months of disease course.average 72 months.Vertebral I degrees 30 patients with narrow spondylolisthesis, II degrees 8 cases with narrow spondylolisthesis.All of the patients have back pain or backleg pain,intermittent claudication 32 cases,sciatica 27 cases,muscle abate 19 cases. Surgery fusion segments:single segment fusion 30 cases, double section 8 cases, total fusion 46 segments.To compare the two treatment operation time, blood loss, hospital stay, operation expenses and complications of the differences.Both groups were in the preoperative and at 3th, 6th and 12th month postoperatively review and determination of the following indicators: Vertebra gap height, disc space activity, fusion rate and JOA score system, Oswestry dysfunction index, etc.Using statistical software SPSS13.0 to determination datas of statistical analysis, measurement data toχ+s says between groups, in groups, compares theχ2 or t test inspection, P <0.05 have statistically significant.Results:Group A were followed up for 8-20 months, the mean was 17 months; Group B were followed up for 12-26 months, the mean was 18 months. There was no significant difference in operation time and hemorrhage amount,length of stay between the two groups (P>0.05),but significant difference in the cost (3.6405±0.1560,2.3466±0.6922) of operation (P<0.05).Cage postoperative relative vertebral gap height significantly higher than preoperative (P< 0.05), respectively, preoperative 7.31±1.58 mm, after 3 months 10.6±1.37 mm, six months after surgery 10.3±1.37 mm,1 year after 10.1±1.32 mm;Cutting lamina joint turkestan group relative vertebral gap height significantly higher than preoperative (P<0.05), respectively, preoperative 7.58±1.55 mm, after 3 months 10.8±1.52 mm, six months after surgery 10.5±1.37 mm,1 year after 10.2±1.33 mm.Groups of postoperative recovery vertebral gap height difference was not significant (P> 0.05).Cage waist push between vertebra Angle is reduced after preoperative activity (P< 0.05), respectively preoperative 8.3±2.65 degrees, after 3 months of 1.4±0.42degrees, six months after surgery 1.4±0.42 degrees,1 year after 0.5±0.43 degree; Cutting lamina joint turkestan group between vertebra Angle is reduced after preoperative activity (P<0.05), respectively, preoperative 7.9±2.62 degrees,after 3 months of 1.4±0.39 degrees, six months after surgery 1.4±0.38 degrees,1 year after 0.5±0.44 degrees. Groups of postoperative recovery than Angle between arom of vertebral no obvious difference (P> 0.05).1 year after Cage fusion rate case group (81.8%) less than cutting lamina joint (89.5%) case group (P<0.05);Cage JOA rating higher than the case group postoperative preoperative (P< 0.05), respectively preoperative 13.8±2.1 points,21.7±1.6 points after the Times follow-up 25.8±.1.7 points. Cutting lamina joint turkestan group JOA rating higher than the case group postoperative preoperative (P< 0.05), respectively, preoperatively 13.6±1.6 points,2.14±1.4 points,after the Times 25.9±1.9 points follow-up. Groups of postoperative recovery JOA score no obvious difference (P> 0.05). Cage Oswestry dysfunction index postoperative below the preoperative (P <0.05), respectively, preoperatively 32.6±2.7 points,21.8±1.5 points after the follow-up sessions 11.6±1.3 points. Cutting lamina joint turkestan group Oswestry dysfunction index case group postoperative below the preoperative (P< 0.05), respectively 6.39±2.3 points preoperatively and postoperatively at the end of 21.5±1.6 points,11.3±1.5 points follow-up sessions. Groups of postoperative recovery Oswestry dysfunction index no obvious difference (P>0.05).Two groups of patients at follow-up time, age, gender, surgical blood loss, at the time of the operation, the length of time, vertebral gap height, between vertebra JOA score, activity, corner Oswestry dysfunction index (ODI) was not statistically significant (P> 0.05).1 case of postoperative cerebrospinal fluid leakage in the Group A, after symptomatic treatment disappeared. And 2 cases received readmission conservative treatment after 4 months appear numbness.In the Group B 1 case appear postoperative cerebrospinal fluid leakage,healed after raised bed and compression bandage by 1 week. And 1 case after 3 months appear waist pain symptoms, received conservative treatment.There were no pseudoarticulation formation, intervertebral space infection, fixation loosen and cage shift in both groups.Conclusions:Through comparing with Cage between vertebra fusion in both surgery, blood loss, hospital stay, operation time, vertebral gap height, between vertebra JOA score, activity, corner Oswestry dysfunction index (ODI) similar basis, the application of autologous lamina joint turkestan cutting into a cylindrical bone graft between vertebra bone graft quashing with pedicle nail great integration system treatment, can well improve degenerative lumbar spinal instability disease clinical symptoms, improving fusion rate, surgery less complications, and reduce the cost of treatment, is a practical clinical technology, can generalizing applied, have good application prospect.
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