摘要
目的观察采用两种手术方法行腰椎管减压、椎体间植骨和SRS内固定治疗腰椎滑脱合并腰椎管狭窄的疗效。方法从1999年9月￣2005年1月,对64例腰椎滑脱患者采用腰椎管减压,椎体间植骨和SRS内固定手术进行治疗,按手术方法不同分为两组:先减压后置钉组34例;先置钉后减压组30例。术前X线检查按Meyerding分度,两组滑脱的程度和临床症状及体征没有统计学差别(P>0.05)。结果术后平均随访36.4个月(4￣64个月),比较两组手术前后临床症状和X线片滑脱复位程度,先减压后置钉组34例患者中,28例症状改善,优良率为82.3%,解剖复位率为95.2%,没有发生神经根损伤;先置钉后减压组30例中,24例症状改善,优良率为80%,解剖复位率为94.2%,神经根损伤5例(16.7%)。两组优良率、解剖复位率没有统计学差别(P>0.05),但神经根损伤(均被术中或再次手术证实为螺钉压迫神经根)发生率有统计学差别(P<0.05)。结论应用SRS内固定治疗腰椎滑脱,效果良好,复位满意;先减压后置钉可减少神经根损伤的发生。
[Objective] To compare the different clinical effect of the treatment of lumbar spondylolisthesis by using posterior pedicle screw instrumented reduction before and after decompressive laminectomy. [Methods] From Sep.1999 to Jan.2005, 64 patiets with lumbar spondylolisthesis were treated with decompressive laminectomy and interbody fusion by bone grafting and posterior pedicle screw instrumented reduction（SRS） in our hospital, they were classified into two groups： group A, whose screw was placed after decompressive laminectomy; group B whose screw was placed before decompressive laminectomy. There were not statistical significances for spondylolisthetic degree （according to Meyerding classification of lumbar spondylolisthesis） and clinical symptoms and signs in two groups（P 〉0.05）. [Results] Average time to follow-up was 36.4 （range 4-64） months. Group A： 28 cases with improved clinical symptoms, satisfactory rate was 82.3%; anatomic reduction rate was 95.2%; no nerve root injury. Group B： 24 cases with improved clinical symptoms, satisfactory rate was 80%; anatomic reduction rate was 94.2%; five cases of nerve root injury occurred （being confirmed during operation or by reoperation because of screw＇s compression on the nerve root）. There were not statistical significances for satisfactory rate and anatomic reduction rate （P 〉0.05）; but there was statistical significance for nerve root injury（P 〈0.05）. [Conclusion] Treatment of lumbar spondylolisthesis with SRS system has satisfactory reduction rate and good clinical results; screw placed after decompressive laminectomy was proposed in order to decrease nerve root injury.
出处
《中国现代医学杂志》
CAS
CSCD
北大核心
2006年第15期2323-2325,共3页
China Journal of Modern Medicine
关键词
腰椎
脊椎前移
减压术
外科
内固定器
脊柱融合术
lumbar vertebrate
spondylolisthesis
decompression, surgical
internal fixators
spondylosyndesis
