椎弓根螺钉内固定及植骨融合治疗退行性腰椎滑脱的临床疗效评价  

Clinical results of pedicle screw fixation in degenerative lumbar spondylolisthesis

作　　者：范永前[1] 梁承伟[1] 沈海敏[1] 

机构地区：[1]华东医院骨科,上海200040

出　　处：《上海医学》2004年第8期578-580,F006,共4页Shanghai Medical Journal

摘　　要：目的　评价腰椎管减压、后外侧植骨和椎弓根螺钉内固定治疗退行性腰椎滑脱的临床疗效。方法　 1993年 1月～ 2 0 0 2年 9月对 74例腰椎退行性滑脱的患者行腰椎管减压、后外侧植骨和椎弓根螺钉内固定 ,采用的椎弓根内固定技术包括Dick 8例、Steffee 10例、RF 9例、Socon 2 5例、Tenor 2 0例、Moss Miami 2例。滑脱水平在L4的患者有 4 4例、L3 有 9例、L5有 16例 ,两节水平的滑脱有 5例。Ⅰ°滑脱 37例 ,Ⅱ°31例 ,Ⅲ°6例。患者平均年龄为 5 3.6岁 (30～ 79岁 )。根据手术前、后日本骨科协会 (TDA)评分评价临床症状改善的程度。结果　平均随访时间为 4 4个月 (12～ 10 4个月 ) ,所有患者最后随访的JOA评分中客观症状为 (6 .7± 1.0 )分 ,临床体征为 (4 .7± 1.1)分 ,日常活动为 (11.8± 1.9)分 ,总评分为 (2 3.0± 2 .5 )分。手术前、后的JOA评分比较 ,术后主观症状改善 70 % ,临床体征改善 6 8% ,日常活动改善 77%。根据患者的年龄分为A组 (30～ 39岁 )、B组 (4 0～ 4 9岁 )、C组 (5 0～ 5 9岁 )、D组 (≥ 6 0岁 ) ,以JOA的评分结果 >2 5分定为满意 ,A、B、C、D组的满意率分别为91%、75 %、6 9%、6 1%。结论　椎板减压、后外侧植骨融合和椎弓根螺钉内固定是治疗不稳定腰椎滑脱的一种有效方法 ,临床疗效?Objective To evaluate the effectiveness of posterior lumbar decompression with bilateral posterolateral arthrodesis and pedicle screw fixtation in patients with degenerative lumbar spondylolisthesis. Methods Follow-up study in a series of 74 patients underwent arthrodesis and pedicle screw fixation. The mean age at the time of operation was 53.6 years. The instrumentations used included: Dick in 8 cases, RF in 10, Steffee in 9, Socon in 25, Tenor in 20 and Moss-Miami in 2 cases. The involved segments were L 4 in 44 cases, L 3 in 9, L 5 in 9, and 5 cases with two segments involved. Results The follow-up period was 12 to 104 months. The Japanese Orthopedic Association (JOA) score increased from 6.5±2.4 points before the operation to 23.0±2.5 points at the time of the study on average. The general improvement rate was 78%. 4 groups of patients showed satisfactory rate with 91% in group A (30～39 years old),75% in group B (40～49 years old), 69% in group C (50～59 years old) and 61% in group D (over 60 years of age). Conclusion The surgical technique of posterior lumbar decompression with bilateral posterolateral arthrodesis and pedicle screw fixtation is an effective method for treatment of degenerative lumbar spondylolisthesis. Early stage operation is recommended in patients over 50 years of age.

关 键 词：椎弓根螺钉内固定 植骨融合 治疗 退行性腰椎滑脱 疗效评价 

分 类 号：R687[医药卫生—骨科学]