Schwab F J, Nazarian D G, Mahmud F, Michelsen C B
Department of Orthopaedic Surgery, Columbia University, College of Physicians and Surgeons, New York, New York, USA.
Spine (Phila Pa 1976). 1995 Sep 15;20(18):2023-8. doi: 10.1097/00007632-199509150-00014.
This study retrospectively, reviewed the effects of pedicle screw fixation on lumbosacral fusion for degenerative conditions. The records and radiographs of a group of patients treated by wide decompression and fusion of the lumbosacral spine and by one surgeon were studied. Two treatment groups were identified by fusion technique; one group received autologous bone graft only, and second group was treated by autologous bone grafting supplemented with pedicle screw fixation.
The two study groups were compared to determine the effects of pedicle screw fixation on lumbosacral fusion for degenerative conditions after wide decompression.
The reported success rate of lumbar and lumbosacral fusion in the literature is variable. Although several studies have reported high fusion rates with internal fixation, few controlled studies have been published. A critical review of isolated lumbosacral fusions (for degenerative conditions) and the effects of instrumentation is necessary to determine the effectiveness and complications associated with pedicle screw systems in this setting.
This study reviewed 215 consecutive patients operated on from 1987 to 1992 for degenerative conditions of the lumbosacral spine. Group 1 included 126 patients who underwent autogenous posterolateral bone graft after decompression. Group 2 included 89 patients treated with Edwards instrumentation and autogenous bone graft. Fusion status was determined via radiographs. Clinical results were based on pain relief after a minimum 2-year follow-up period.
In Group 1, an overall fusion rate of 65% was obtained. Clinically, 56% had good or excellent results. Complications included pseudarthroses (35%), dural tears (3.2%), and infection (2.4%). In Group 2, a fusion rate of 91% was achieved. In this group, 89% had a good or excellent clinical result. Complications included pseudarthroses (9%), dural tears (2.2%), and infection (2.2%).
Use of pedicle screw and rod fixation with the Edwards system led to significantly improved results in lumbosacral fusions over autogenous bone graft alone, with a lower complication rate. The use of spinal is a valuable adjunct to achieve lumbosacral fusion in patients who have undergone decompressive surgery for the spine.
本研究回顾性分析了椎弓根螺钉固定术对退行性疾病腰骶部融合术的影响。研究了一组由同一位外科医生进行腰骶部广泛减压融合术治疗的患者的病历和X光片。根据融合技术确定了两个治疗组；一组仅接受自体骨移植，第二组采用自体骨移植并辅以椎弓根螺钉固定。
比较两个研究组，以确定椎弓根螺钉固定术对广泛减压后退行性疾病腰骶部融合术的影响。
文献报道的腰椎和腰骶部融合术的成功率各不相同。虽然有几项研究报告了内固定的高融合率，但发表的对照研究很少。对孤立的腰骶部融合术（针对退行性疾病）及器械的影响进行严格审查，对于确定在这种情况下椎弓根螺钉系统的有效性和并发症是必要的。
本研究回顾了1987年至1992年因腰骶部退行性疾病接受手术的215例连续患者。第1组包括126例减压后接受自体后外侧骨移植的患者。第2组包括89例接受爱德华兹器械和自体骨移植治疗的患者。通过X光片确定融合状态。临床结果基于至少2年随访期后的疼痛缓解情况。
在第1组中，总体融合率为65%。临床上，56%的患者效果良好或极佳。并发症包括假关节形成（35%）、硬脑膜撕裂（3.2%）和感染（2.4%）。在第2组中，融合率达到91%。在该组中，89%的患者临床效果良好或极佳。并发症包括假关节形成（9%）、硬脑膜撕裂（2.2%）和感染（2.2%）。
使用爱德华兹系统的椎弓根螺钉和棒固定术在腰骶部融合术中的效果明显优于单纯自体骨移植，且并发症发生率更低。脊柱内固定器械的使用是为接受脊柱减压手术的患者实现腰骶部融合的一种有价值的辅助手段。
