后路椎体间植骨融合术治疗老年腰椎间盘突出症  

Posterior lumbar Interbody Fusion(PLIF) in elderly lumbar Disc Herniation

作　　者：滕晓[1] 梁裕[2] 王勇[1] 张招波 

机构地区：[1]浙江省台州市中心医院,浙江台州318000 [2]上海第二医科大学附属瑞金医院,上海200025

出　　处：《实用骨科杂志》2004年第4期314-316,共3页Journal of Practical Orthopaedics

摘　　要：目的　探讨后路椎体间植骨融合术治疗老年椎间盘突出症的手术技术并评价其应用价值。方法　对明确诊断为老年椎间盘突出症的 36例患者进行后正中入路下的椎间盘切除 ,椎管狭窄减压 ,椎弓根螺钉植入并行椎间隙撑开 ,保留侧方以及前方的纤维环 ,刮除终板的软骨层 ,植入足量的松质骨以及椎板关节突切除物 ,最后植入双条三面皮质骨的髂骨块 ,椎弓根螺钉系统加压固定。结果　平均手术时间为 110 m in,平均失血量较常规手术多 10 0 m L。33例获得手术后的 3个月随访 ,原有的神经压迫症状大部分恢复 ,行走距离增加明显 ,下腰痛缓解最为明显。椎间高度术前 2 .6～ 6 .8m m,平均高度 4 .1mm,术后椎间高度 11.6～ 14 .2 m m,平均 12 .6 mm。在 3个月随访时平均高度为 10 .9～ 13.3mm,平均为 11.8mm。椎间孔 3个月后较术前增加 6 mm。 31例显示椎间隙的活动度小于 2°,椎体与植骨块交界处无透亮区。 2例植骨块有部分吸收 ,但症状改善。最常见的并发症为脑脊液漏和神经根牵拉刺激 ,最终缓解。结论　后路椎体间植骨融合结合椎弓根螺钉系统固定治疗老年腰椎间盘突出症满足充分减压 ,椎间隙高度恢复和稳定性重建以及长期可靠融合治疗的基本要素。Objective To investigate posterior lumbar interbody fusion (PLIF) technique and its clinical value in elderly lumbar disc herniation. Methods Among 36 cases with elderly lumbar Disc Herniation,decompression for stenosis were performed firstly,pedicle screws were conducted and intervertebral space increased,disc was removed while the anterior and lateral wall of fibrosus annulus were well preserved,the cartilage layer of end plate were gently curetted,enough cancellous bone harvested from iliac crest were inserted into the space. Finally,tricortical bone grafts were grafted and pedicle screw system with compression and locking was installed. Results With this procedure,mean operation time was 110 minutes and blood loss was 100 mL over common procedure. 33 cases were followed-up for 3 months. Neurodeficit were recovered in most case,walk distance increased obviously,providing significant lumbar pain relieve. Averaging interbody height was 4.1 mm(2.6～6.8) before operation,and 12.6 mm(11.6～14.2)just after operation and 11.8 mm(10.9～13.3) months after operation. The height of foramen enlarged with 6 mm. With dynamic radiography the range of motion were less than 2°. There were no transparent region at the interface between the vertebral body and bone graft. Bone graft absorbed in 2 cases,but the symptoms were diminished. The common complications were the leakage of CSF and the tension irritation of the nerve root which could be relieved at last. Conclusions PLIF technique meets the need of complete decompress,interbody height reconstruction,instant stability and sound bony fusion in the elderly lumbar disc herniation.

关 键 词：后路椎体间植骨融合术 外科治疗 老年 腰椎间盘突出症 椎弓根螺钉 

分 类 号：R681.53[医药卫生—骨科学]