退变性腰椎不稳的外科治疗  

Surgical treatment of degnenerative instability of lumbar spine

作　　者：李光磊[1] 路世勇[1] 魏勇[1] 朱海波[1] 段强民[1] 吕云亮[1] 常西海[1] 李福东[1] 闫德强[1] 

机构地区：[1]山东省淄博市临淄区人民医院骨科,255400

出　　处：《中国矫形外科杂志》2007年第21期1607-1609,共3页Orthopedic Journal of China

摘　　要：[目的]探讨退变性腰椎不稳的诊断、椎管手术减压范围及固定融合原则。[方法]对本院2000年2月～2006年10月158例退变性腰椎不稳手术治疗的患者进行回顾性分析，术前常规检查腰椎正侧位，前曲后伸动力位X线片及CT检查，手术采用后路减压椎弓根螺钉系统内固定，椎体间或横突植骨融合，1周后根据内固定情况戴支具或不戴支具下床活动，6个月后基本恢复正常活动。[结果]术前椎管横截面积56～114mm^2，平均74mm^2，术后椎管横截面积204～296mm^2，平均221mm^2，比术前扩大3倍。随访6个月～5年，平均2年5个月，术前（JOA）评分平均3．7分，术后平均13．2分，症状体征改善率85％，术前术后有明显统计学意义，根据改善率优108例，良46例，可3例，差1例，全组优良率97．5％。[结论]采用椎管减压、椎弓根螺钉系统内周定，植骨融合，可有效的维持和重建脊柱的稳定，解除患者症状，是目前治疗退变性腰椎不稳较好的治疗方法。[ Objective] To investigate diagnosis of lumbar instability, segment of spinal canal decompression and principle of fixation and fusion. [ Method] 158 cases of degnenerative lumbar instability from Feb 2001 and Oct 2006 in our hospital were analyzed retrospectively, the patients were operated with posterior decompression, instrumentation with pedicle screw and interbody or inter-transverse fusion. Patients all were examined with lumbar radiographys of lateral flexion and extension and with lumbar CT befor operation, Patients began to walk after operation one week, 6 months later, restore to normal activities. [ Result] The preoperative spinal canal area was 56 -114 mm^2, averaged 74 mm^2 , the postoperative spinal canal area 204 - 296 mm^2, averaged 221 mm^2. The patients were followed up from 6 months to 5 years （averaged 2 years and 5 months）. The score was evaluated according to the JOA score. The preoperative score was averaged 3.7, the postoperative score was averaged 13. 2, the improving rate was averaged 85%. 108 case excellent, 46 good, 3 fairand 1 bad, The excellent and good rate was 97. 5% in this group. [ Conclusion] The spinal stability can be effectively maintained and reconstructed by decompression of spinal canal and instrumentation with pedicle screw system and fusion, which is a good method for treating Degnenerative instability of lumbar spine.

关 键 词：退变性 腰椎不稳 椎管减压 内固定 植骨融合 

分 类 号：R687.3[医药卫生—骨科学]