后外侧或后路环形融合内固定治疗改善腰椎峡部裂性椎体滑脱患者下腰痛及功能活动障碍的效果  

Effect of posterolateral arthrodesis or posteriorly circumferential spinal fusion combined with posterior instrumentation in improving the low back pain and disorders of functional activity in patients with isthmic spondylolisthesis

作　　者：谭俊铭[1] 李家顺[2] 叶晓健[2] 冯水云[1] 袁文[2] 梁再跃[1] 何海龙[2] 许国华[2] 贾连顺[2] 

机构地区：[1]解放军第八十九医院骨一科,浙江省湖州市313000 [2]解放军第二军医大学长征医院骨科,上海市200003

出　　处：《中国临床康复》2005年第34期77-79,i0004,共4页Chinese Journal of Clinical Rehabilitation

摘　　要：目的:回顾性评估腰椎峡部裂性椎体滑脱(Ⅰ度～Ⅲ度)患者行后外侧或后路环形融合内固定术后患者腰和下肢痛及腰和下肢功能活动的改善效果。方法:选者1993-02/2002-09解放军第八十九医院骨科和第二军医大学长征医院骨科门诊治疗峡部裂性椎体滑脱患者44例,患者均签署知情同意书。均为单一椎体双侧峡部裂,其中行后外侧融合内固定26例,后路360°融合内固定18例。随访两年进行效果评定:①临床疗效评估为优:腰和下肢痛完全消失,可下蹲;良:腰和下肢痛大部分消失,能下蹲;可:疼痛部分消失,常用止痛药,下蹲轻度受限;差:疼痛同前或加重,常规用止痛药,没有支持不能下蹲。②植骨融合情况根据X射线片和CT片评定。结果:按意向处理分析,44例患者均进入结果分析。①后外侧融合内固定和后路360°融合内固定患者临床效果:优5例,良36例,可2例,差1例,优良率达93.2%(41/44)。②植骨融合情况:除预后差的1例患者融合失败和另1例内固定取出时仍存在峡部异常活动外,其他42例均骨性融合,融合率为95.4%(42/44)。③不良事件和副反应:7例患者遗有术后取骨部位的慢性疼痛,经对症处理后好转。结论:结果证实只要术中重视植骨融合技术,则峡部裂性椎体滑脱患者行后外侧融合内固定或360°融合内固定均能获得较好的滑脱纠正率和植骨融合率,较好缓解患者腰和下肢疼痛症状,并恢复下蹲等功能活动。AIM： To retrospectively evaluate the ameliorative effect on the pain in waist and lower limbs and the functional activity of lower limbs in patients with isthmic spondylolisthesis （Ⅰ°-Ⅲ°） after posterolateral arthrodesis or posteriorly circumferential spinal fusion combined with posterior instrumentation. METHODS： From February 1993 to September 2002, 44 patients with isthmie spondylnlisthesis, who were treated in the orthopaedic departments of the 89 Hospital of Chinese PI,A and Changzheng Hospital of the Second Military Medical University of Chinese PLA, participated in the study voluntarily. They all had a bilateral defect of the pars interarticularis with vertebral slippage, including 26 cases received posterolateral arthrodesis and 18 cases received posteriorly circumferential spinal fusion. They were followed up for 2 years for evaluation of the effect： ① standards of the evaluation： excellent was the complete disappearance of the pain in waist and lower limbs, and able to squat; good was the disappearance of most pain in waist and lower limbs, and able to squat; moderate was the disappearance of part pain, frequent use of antalgica, and restricted range of squatting; bad was unameliorated or aggravated pain, regular use of antalgica, and unable to squat without support.② The fused condition of the grafted bone was assessed according to the radiography and CT results. RESULTS： According to intention-to-treat analysis, all the 44 patients were involved in the analysis of results. ① The clinical effect in the patients treated with posterolateral arthrodesis and posteriorly 360° fusion： It was excellent in 5 eases, good in 36 eases, moderate in 2 cases and bad in 1 case respectively, and the rate of excellent and good was 93.2% （41/44）. ② The fused condition of the grafted bone： One case with bad prognosis had failed fusion, another 1 case still had isthmic abnormal activity when the internal fixation was taken out, the other 42 cases had bone fusion, and the fusion rate wa

关 键 词：脊柱裂 隐性 腰椎 脊柱融合术 内固定器 

分 类 号：R681[医药卫生—骨科学]