摘要
目的探讨创伤性腰椎滑脱症的临床特征及经后路手术治疗的近期疗效。方法回顾分析2008年1月-2012年6月收治的11例创伤性腰椎滑脱症患者临床资料。男6例,女5例;年龄13～60岁,中位年龄38岁。致伤原因:重物砸伤4例,高处坠落伤4例,交通事故伤3例。受伤至手术时间3 d～13年,中位时间20 d。术前神经功能Frankel分级为:E级2例,D级4例,C级3例,B级2例。X线片示L4滑脱3例,L58例。根据Meyerding分度:Ⅰ度4例,Ⅱ度4例,Ⅲ度2例,Ⅳ度1例。手术固定节段:L4、52例,L5、S17例,L4～S12例。行椎间及后外侧360°植骨融合8例,仅行后外侧植骨3例。术后随访行腰椎正侧位X线片及CT三维重建评价滑脱复位及植骨融合情况,通过疼痛视觉模拟评分(VAS)及Oswestry功能障碍指数(ODI)进行疗效评价。结果术后患者切口均Ⅰ期愈合。11例术后均获随访,随访时间6～40个月,中位时间12个月。无内固定物拔出、断裂等情况发生。CT三维重建显示患者植骨均融合,融合率100%,融合时间3～6个月,平均4.5个月。末次随访时腰椎X线片示滑脱Meyerding分度为0度10例,Ⅰ度1例,与术前比较差异有统计学意义(Z=—2.979,P=0.003)。末次随访时神经功能Frankel分级为E级6例,D级3例,C级2例,较术前显著改善(Z=—2.271,P=0.014)。术后1周及末次随访时VAS、ODI评分均较术前显著改善(P<0.05);术后1周和末次随访间比较差异无统计学意义(P>0.05)。结论急诊腰椎X线片发现多发横突骨折,结合患者受伤机制应高度怀疑创伤性腰椎滑脱症,尽早行经后路椎管减压、植骨融合内固定手术有助于创伤性腰椎滑脱症患者神经功能恢复,获得满意近期疗效。
Objective To analyze the clinical features and preliminary outcome of posterior operation for traumatic lumbar spondylolisthesis. Methods The clinical data of 11 patients with traumatic lumbar spondylolisthesis who underwent surgeries between January 2008 and June 2012 were retrospectively analyzed.There were 6 male and 5 female patients,aged from 13 to 60 years with a median age of 38 years.The mechanism of injury included heavy pressure injury in 4 cases,falling injury from height in 4 cases,and traffic accident injury in 3 cases.The time of injury to operation was between 3 days and 13 years（median,20 days）.According to Frankel neurological function grading,2 patients were rated as grade E,4 as grade D,3 as grade C,and 2 as grade B before operation;according to Meyerding spondylolisthesis grading,4 cases were classified as degree I,4 as degree II,2 as degree III,and 1 as degree IV preoperatively.The affected segments included L4 in 3 and L5 in 8 patients.The surgical fixation segments were L4,5 in 2 patients,L5,S1 in 7,and L4-S1 in 2.Eight patients underwent circumferential fusion,while 3 patients underwent posterolateral fusion.The reduction of spondylolisthesis and bone graft fusion were assessed on X-ray films and three-dimensional CT scans during follow-up.The clinical outcomes were evaluated by visual analogue scale（VAS） and Oswestry disability index（ODI） scores. Results All patients achieved primary healing of incision after operation.And all patients were followed up 6-40 months with a median time of 12 months.There was no pulling-out or breaking of internal fixation.The fusion rate was 100% on three-dimensional CT scans,and the fusion time was 3-6 months（mean,4.5 months）.The spondylolisthesis was degree 0 in 10 cases and degree I in 1 case according to Meyerding grading,showing significant difference when compared with preoperative spondylolisthesis grading（Z= —2.979,P=0.003）.The Frankel neurological function grading were E in 6,D in 3,and C in 2 at last follow-up,which were significantly improved when compared with preoperative one（Z=— 2.271,P=0.014）.At 1 week after operation and last follow-up,VAS and ODI scores were significantly improved when compared with the preoperative scores（P 0.05）;however,no significant difference was found between at 1 week and at last follow-up（P 0.05）. Conclusion If lumbar X-ray films suggest multiple fractures of transverses in emergency combined with the mechanism of injury,it strongly indicates the diagnosis of traumatic lumbar spondylolisthesis,moreover earlier decompression and fusion can provide the recovering of the neurological function and satisfactory preliminary effectiveness in these patients.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2013年第8期965-968,共4页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
创伤性腰椎滑脱症
临床特征
后路固定融合术
Traumatic lumbar spondylolisthesis Clinical feature Posterior fixation and fusion
