摘要
目的 探讨后路椎间融合术治疗连续两节段双侧峡部裂型腰椎滑脱症的疗效。方法 2008年2月-2013年12月,采用后路减压、椎间融合术治疗17例连续两节段双侧峡部裂型腰椎滑脱症患者。男12例,女5例;年龄48~69岁,平均55.4岁。病程11个月~17年,中位病程22个月。滑脱程度按照Meyerding分度：Ⅰ度30个节段,Ⅱ度3个节段,Ⅲ度1个节段;涉及节段：L_（4、5）14例,L_（3、4）3例。术前疼痛视觉模拟评分（VAS）为（8.6±3.2）分。结果 术中2例硬脊膜撕裂出现脑脊液漏;其余患者切口均Ⅰ期愈合,无其他手术相关并发症发生。患者均获随访,随访时间1~6年,平均3.4年。末次随访时,VAS评分为（1.1±0.4）分,与术前比较差异有统计学意义（t=7.652,P=0.008）。术后1周X线片检查示,滑脱椎体均获得不同程度复位,完全复位率为85%（29/34）。术后6~12个月达椎间融合,平均7.4个月;椎间融合按Lenke标准评价：A级13例,B级4例。随访期间均无内固定物松动、断裂;椎间高度维持良好,滑脱椎体复位无丢失。结论 后路椎间融合术治疗连续两节段双侧峡部裂型腰椎滑脱症可取得较好疗效,术中准确植钉、有效减压、先撑开后复位、合理使用提拉螺钉、椎间融合是手术成功关键。
Objective To explore the effectiveness of posterior lumbar interbody fusion in the treatment of double-segmental bilateral isthmic lumbar spondylolisthesis. Methods Between February 2008 and December 2013, 17 patients with double-segmental bilateral isthmic lumbar spondylolisthesis were treated with posterior lumbar interbody fusion. There were 12 males and 5 females, with an age ranged 48-69 years （mean, 55.4 years）. The disease duration ranged from 11 months to 17 years （median, 22 months）. According to the Meyerding classification, 30 vertebrea were rated as degree Ⅰ, 3 as degree Ⅱ, and 1 as degree Ⅲ. L4, 5 visual analogue scale （VAS） score was 8.6±3.2. Results was involved in 14 cases and L3, 4 in 3 cases. The preoperative Cerebrospinal fluid leakage occurred in 2 cases because of intraoperative dural tear; primary healing of incision was obtained, with no operation related complication in the other patients. The patients were followed up 1-6 years （mean, 3.4 years）. At last follow-up, VAS score was decreased significantly to 1.1±0.4, showing significant difference when compared with preoperative score （t=7.652, P=0.008）. X-ray films showed that slippage vertebral body obtained different degree of reduction, with a complete reduction rate of 85% （29/34） at 1 week after operation. All patients achieved bony union at 6-12 months （mean, 7.4 months）. According to the Lenke classification, 13 cases were rated as grade A and 4 cases as grade B. No internal fixation loosening and fracture were observed during the follow-up. Intervertebral disc height was maintained, no loss of spondylolisthesis reduction was found. Conclusion It can obtain satisfactory clinical result to use spinal canal decompression by posterior approach, and screw fixation for posterior fusion in treatment of double-segmental bilateral isthmic lumbar spondylolisthesis. The key points to successful operation include accurate insertion of screw, effective decompression, distraction before reduction, rational use of pulling screws, and interbody fusion.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2015年第12期1500-1503,共4页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
峡部裂型腰椎滑脱症
双节段
后路椎间融合术
Isthmic lumbar spondylolisthesis
Double segments
Posterior lumbar interbody fusion
