摘要
目的探讨骨水泥强化下腰后路减压植骨融合内固定术治疗退变性腰椎滑脱症伴滑脱椎体骨折的有效性。方法回顾性分析2007年7月至2011年3月,于我院行手术治疗的17例退变性腰椎滑脱症合并滑脱椎体压缩骨折患者的临床及影像学资料,所有患者均表现为腰痛伴或不伴有下肢神经根刺激症状,MRI证实滑脱椎体T_2加权像及STIR序列高信号。记录患者的手术时间、出血量、并发症及骨水泥的注入量。采用Taillard指数评估椎体滑脱程度及术后复位情况,采用疼痛视觉模拟评分评估手术前后腰痛的程度。结果所有患者均获得1年以上随访,骨水泥的注入量平均(4.2±0.7)ml,手术时间平均为(167±28)min,术中出血量平均为(708±45)ml,腰痛VAS评分术后1年随访时改善为(4.6±0.2)分,术前Taillard指数平均为(17.6±1.8)%,术后为(8.2±1.3)%,滑脱复位率为53.4%;所有病例均未发生严重骨水泥渗漏及神经血管并发症,末次随访时植骨均已融合,未发现椎间融合器移位及螺钉松动、断裂、脱出等内固定物相关并发症。结论骨水泥强化下腰后路减压植骨融合内固定术,是治疗退变性腰椎滑脱症伴滑脱椎体骨折的有效方法,骨水泥的应用增加了椎弓根螺钉把持力,彻底的减压及植骨融合改善了神经刺激症状,疗效确切。
Objective To explore the effects of posterior lumbar interbody fusion （ PLIF ） and polymethylmethacrylate （ PMMA ） for degenerative lumbar spondylolisthesis combined with vertebral fractures. Methods 17 patients with degenerative lumbar spondylolisthesis combined with vertebral compression fractures underwent the surgical treatment of PLIF and PMMA in our hospital from July 2007 to March 2011, whose clinical and imaging data were retrospectively analyzed. All the patients complained of low back pain with or without nerve root irritation of lower limbs. The Magnetic Resonance Imaging （ MRI ） showed high signal on T2-weighted images and of the Software for Tomographic Image Reconstruction （ STIR ） sequence. The surgery time, blood loss, complications, cement amount of the patients were recorded. The TaiUard index was used to evaluate the spondylolisthesis degree and the postoperative reduction, and the Visual Analogue Scale （ VAS ） to assess the degree of low back pain before and after the operation. Results All the patients were followed up for more than 1 year. The mean cement amount was （ 4.24.0.7 ） ml, the mean operation time was （ 167^-28 ） min, and the mean intraoperative blood loss was （ 7084- 45 ） ml. The VAS score of low back pain was improved to （ 4.64.0.2 ） points at the 1st year after the operation, and the mean Taillard index was （ 17.64-1.8 ） % and （ 8.24-1.3 ） % preoperatively and postoperatively. The reduction rare of spondylolisthesis was 53.4%. No severe leakage of bone cement or neurovascular complications occurred in all the patients. Bony fusion was achieved, and no complications such as the displacement of the cage or the loose, breakage or slipping out of screws were found in the latest follow-up. Conclusions It is an effective method of PLIF and PMMA in the treatment of degenerative lumbar spondylolisthesis combined with vertebral fractures, with good curative effects. The holding force ofpedicle screws is increased after the usage of PMMA, and the nerve root irritation is improved by the complete decompression and interbody fusion.
出处
《中国骨与关节杂志》
2014年第1期5-9,共5页
Chinese Journal of Bone and Joint
关键词
骨水泥成形术
减压术
外科
骨折固定术
内
脊柱融合术
脊椎滑脱
脊柱骨折
腰椎
Cementoplasty
Decompression, surgical
Fracture fixation, internal
Spinal Fusion
Spondylolysis
Spinal Fractures
Lumbar vertebrae
