腰椎退行性不稳的诊断与临床疗效分析  

The degenerative lumbar instability: The diagnosis and curative effect of surgical intervention

作　　者：顾洪生[1] 李振宇[1] 肖建德[1] 阎洪印[1] 田长庆[1] 周文钰[1] 于从[1] 

机构地区：[1]深圳市第二人民医院脊柱外科,广东深圳518035

出　　处：《中国临床解剖学杂志》2007年第4期470-472,共3页Chinese Journal of Clinical Anatomy

摘　　要：目的:探讨腰椎退行性不稳症的临床诊断、治疗方法及其临床疗效。方法:自1997年8月至2006年12月,手术治疗44例腰椎退行性不稳症。本组男28例,女16例,年龄27～78岁,平均51.6岁。所有病例依统一标准入选,并常规行腰椎正侧位片、动力位片、MRI等检查,9例行椎间盘造影。全部病例分别行后路全椎板或半椎板切除,单节段或多节段开窗减压;变性突出的髓核摘除;各式内固定或单纯植入内植物;椎间或横突间植骨融合术。术后佩戴外固定支柱3月,并定期随访。结果:腰椎退行性不稳症的诊断依据下列标准:L4/5过屈时移位>8%,过伸时移位>9%;L5/S1过屈时移位>6%,过伸时移位>9%;或者椎体前后移位≥4mm,终板成角≥10°。全部病例均获得随访,随访时间6～52个月,平均20.4个月。依据JOA评分标准,总改善率66%。结论:(1)典型的临床症状、影像学改变以及保守治疗无效患者方可考虑手术治疗;(2)有效的减压、合适的固定、正确处理椎间盘是治疗的重要手段;(3)椎间盘造影、弹性固定在腰椎退行性不稳症中的应用,值得进一步研究。Objective： To discuss the diagnosis, the treatment methods and the clinic curative effects of the degenerative lumbar instability. Methods： From August 1997 to December 2006, 44 cases had been performed lumbar operation （28 males and 16 females, aged from 27 to 78, averagely 51.6 years）. All patients were be selected according to an unified standard, and examined lumbar anterior and lateral position X-ray film, lumbar dynamics position X--Ray film and MRI. 9 cases were inspected in discography. The operation style included semi or total laminectomy, single or multiply segments fenestration, denaturalization or protrudent nucleus pul- posus tissues excision, varied internal fixation and intervertebral or intertransverse bone grafting fusion. All patients worn outer fixation brace 3 months atter operation and followed up at regular intervals. Results： The diagnosis standard of the degenerative lumbar instability should be defined as follows： excessive flexion displace ment 〉8% or excessive extension displacement 〉9% in L45; excessive flexion displacement 〉6% or excessive extension displacement 〉9% in L5/S1; the endplateangle exceed in 10° or 4 mm vertebral body displacement in anteroposterior position in X-Ray film. All patients were followed up from 6 to 52 months with the average of 20.4 months. The total amendatory ratio was 66% according to the JOA grade. Conclusions： l.The surgery op eration should be considered only to those patients who posses typical clinical symptoms, images varying and conservative treatment in vain; 2. Validation depression, appropriate fixation and proper handle intervertebral disc are important methods; 3. The discography and flexibility fixation are worth further study in degenerative lumbar instability.

关 键 词：腰椎退行性不稳 腰椎 脊柱融合 腰椎重建 

分 类 号：R681.5[医药卫生—骨科学]