摘要
目的回顾后路椎管减压、器械复位内固定术治疗腰椎滑脱的临床效果,探讨主要并发症的发生原因及应对措施。方法回顾分析1997年1月～2002年12月间收治的190例采用后路椎管减压、器械复位内固定治疗的腰椎滑脱病例的手术及术后随访情况。男65例,女125例;年龄34～87岁,平均56.3岁。单节段滑脱175例,双节段滑脱15例。Ⅰ度滑脱148例(77.9%),Ⅱ度滑脱42例(22.1%)。结果190例中35例患者术后6个月后失随访,其余155例平均随访时间17.2个月(7～61个月)。190例患者术后6个月时滑脱节段维持解剖复位,后外侧植骨融合良好。围手术期并发症:硬膜撕裂1例,伤口并发症(感染、脂肪液化、不愈合)5例,切口血肿3例,术后一过性下肢神经症状13例,术后疼痛14例。远期并发症:持续下腰痛11例,持续下肢神经症状5例,内固定失败5例,假关节形成3例。6例接受翻修手术。结论腰椎滑脱的后路复位内固定具有较好的临床效果,下肢神经症状、下腰痛及融合固定失败是主要并发症,应给予高度重视。
Objective To evaluate the clinical outcome of lumbar spondylolisthesis treated by de-compression,instrumentation and posterolateral fusion in order to analyze the causes and the management of peri-and post-operative complications as well as improve the surgical management of lumbar spondylolisthe-sis.Methods From Jan uary1997to De cem ber2002,190cases with gradeⅠtoⅡspondylolisthesis treated by posterior lumbar canal decom pression,re duction with pedicle screw systems and fusion with posterolateral bone grafting were re viewed.There were65males and125fe males with an average age of 56.3years from34to87years.175cases in volved one seg ment and other15cases in volved two segments.According to Meyerding classification,there were148cases(77.9%)of gradeⅠand42cases(22.1%)of gradeⅡ.There were isthmic spondylolis thesis in67,degenera tive spondylolisthesis in121and traumatic spondylolisthesis in2.The mean time of operation was245min utes,the mean blood loss was407ml,and the drainage volume was451ml.The decompression of lumbar spine was in single lev el in119cases,double level in64cases and more than two lev els in10cases.The fixed segment was single level in127cases,double level in52cases and more than two levels in11cases.The mean postoperative time in bed was8.2days,and the patients wore brace from3to6months.Results35cases were lost after6months follow-up,other155cases were followed up over6months,and the average time of fol low-up was17.2months from7to61months.The complications of peri-operative period were8.3%,which included dural laceration in1(0.5%),wound infec-tions in5(2.6%),hematoma in3(1.6%),transient neu rological deficits in13(6.9%),and fever over one week in2(1.1%).The long-term complications included persis tent low back pain in11(5.8%),persistent neurological deficits in5(2.6%),implant failures in5(2.6%),and pseu doarthro sis formation in3(1.6%).The radiologi cal examination of A-P and lateral view were taken in all patients at3to5days postoperative-ly,and all patients obtained anatomi cal reduction of spondylolisthesis,which were maintained at6months follow-up.6cases received revision.Conclusion Good clinical re sult has been obtained in using posterior reduction and fixation with pedicle screw system dealing with grade I and grade II lumbar spondylolisthesis.Neurological deficits,postoperative pain and im plant failures are the common com plications,and more atten-tion should be paid for preventation.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2003年第11期661-664,共4页
Chinese Journal of Orthopaedics
关键词
腰椎滑脱
内固定术
并发症
器械复位内固定术
Lumbar vertebrae
Spondylolisthesis
Intraoperative complications
Postoperative com-pli cations
