摘要
目的观察腰椎管减压、横突间植骨和SOCON内固定手术治疗不稳定型退行性腰椎滑脱合并腰椎管狭窄患者的早期临床疗效。方法从1997年12月～1999年1月 ,21例腰椎退行性滑脱合并腰椎管狭窄的患者 ,经长期 (6～12个月 )严格保守治疗失败后 ,入院接受腰椎管减压、横突间植骨和SOCON内固定手术。21例中表现为下腰痛、间歇性跛行者19例 ,下肢疼痛者8例。经术前X线检查证实MeyerdingⅠ度滑脱18例 ,Ⅱ度滑脱3例 ;滑脱部位L3 ,4 2例 ,L4 ,5 12例 ,L5S1 7例。术后平均随访8.3个月 (3～16个月 ) ,对照比较手术前后临床症状改善和X线片滑脱复位程度。结果21例患者中 ,19例术后症状完全消失。18例Ⅰ度滑脱者17例术后X线检查证实完全复位 ;3例Ⅱ度滑脱患者 ,2例完全复位 ,1例滑脱复位70 %。21例无一例发生神经系统并发症及感染 ,1例患者术前因两个节段腰椎滑脱 ,而行三个节段腰椎固定术 ,术后残留部分腰痛症状 ;1例因合并颈椎、胸椎椎管狭窄 ,而残留部分跛行。结论运用SOCON内固定治疗腰椎滑脱 ,术后早期随访效果良好 。
Objective To observe the early clinical outcome of the instable degenerative lumbar spondylolisthesis treated by decompressive laminectomy, intertransverse process arthrodesis with bone grafting and transpedicle instrument of solid connection(SOCON) system. Methods From December 1997 to January 1999, twenty-one patient, were diagnosed as degenerative lumbar spondylolisthesis accompanied by lumbar canal stenosis by the imaging studies of plain radiographs, myelogram, computerized tomography scan and MRI. There were 6 males and 15 females, aged from 30 to 77 years old, with an average of 53.3 years. The clinical manifestations of the patients included intermittent claudication in 19, pain of lower extremity in 8. According to Meyerding classification system of lumbar spondylolisthesis, 18 cases were classified as degree 1, 3 cases degree 2. The levels of lumbar spondylolisthesis was between L 3 and L 4 in 2 patients, between L 4 and L 5 in 12, between L 5 and S 1 in 7. The decomprssion of the spinal canal stenosis was achieved by lumbar laminectomy, the concomitant intertransverse process arthrodesis was performed by means of bone chip grafting harvested from the iliac crest, and SOCON system was installed by pedicle screw fixation devices. Results The patients were followed up from 3 to 16 months, with an average of 8.3 months. The results showed that the pre-operative clinical symptoms disappeared completely in 19 of 21 patients,pain relief was seen in 90.5%. 17 of 18 cases with degree 1 and 2 of 3 degree 2 spondylolisthesis obtained complete reduction of the olisthy vertebral bodies, anatomical reduction rate was 90.5%. No infection or neurologic complication occurred in this series. Two cases suffered from residual symptoms. One case sustained residual low back pain, which received the three segmental lumbar fixations, because of the two lumbar spondylolisthesis,another one was associated with cervical and thoracic stenosis, the claudication of this case did not recovered completely. Conclusion This study showed decompressive laminectomy, intertransverse process arthrodesis and transpedicle instrument of SOCON system in the treatment of lumbar spondylolisthesis have the advantages of satisfactory preliminary clinical result, high reduction rate and low complication.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2000年第5期275-278,共4页
Chinese Journal of Orthopaedics
关键词
腰椎退行性滑脱
SOCON内固定器
外科手术
Lumbar vertebrae
Spondylolisthesis
Internal fixators
Surgical procedures,operative
