腰椎滑脱伴邻近节段退变的诊疗分析  

Diagnosis and treatment of adjacent segment degeneration following spondylolithesis

作　　者：刘涛[1] 李长青[1] 周跃[1] 王建[1] 初同伟[1] 张东[1] 

机构地区：[1]第三军医大学新桥医院骨科,重庆400037

出　　处：《中国矫形外科杂志》2009年第2期102-105,共4页Orthopedic Journal of China

摘　　要：[目的]探讨腰椎滑脱伴邻近节段退变诊断、治疗效果及其临床意义。[方法]自2000年10月～2005年10月,对16例腰椎滑脱伴邻近节段退变患者行切开复位内固定术,采用Prolo腰椎功能评定评估腰椎术后功能,影像学评估椎体滑脱复位程度、椎间隙高度、固定节段前凸的恢复、融合器位置、植骨融合情况及内固定物有无松动等,对X线片结果可疑病例,追加CT检查。[结果]本组14病例获得随访,平均随访时间28个月(16～53个月);术后3个月Prolo评分结果:7分3例,8分7例,9分2例,4分2例,优良率为85.7%;末次Prolo评分结果:7分4例,8分6例,9分4例,优良率为100%;术后6个月有8例达到骨融合标准,占66.7%,术后12个月有13例达到骨性融合标准,占92.9%;1例椎间融合可疑,患者没有临床症状和体征。术后1周复查X线片显示:完全复位10例,占71.4%,4例复位>50%,术后12个月及末次随访复查没有出现复位丢失。术前、术后3个月及末次随访腰椎前凸角分别为26.64°、33.29°、32.36°;术前、术后6个月及末次随访固定节段前凸角分别为15.64°、28.29°、32.36°;椎间隙高度术前、术后分别为6.54 mm、9.62 mm,术前与术后相比有统计学意义(P<0.05)。所有患者没有出现伤口感染、神经损伤等并发症,无内固定物断裂、松动;没有出现椎间融合器位置不良、塌陷、移位等并发症。[结论]腰椎滑脱伴邻近节段退变发病率和治疗具有自身的临床特点;采用双节段或三节段固定、融合近、中期临床效果优良,是一种有效、安全的方法。[ Objective] To investigate the diagnostic methods and clinical effects of the management of spondylolithesis with adjacent segment degeneration. [ Method] Between October 2000 and October 2005, 16 consecutive patients （3 males and 13 females） aging 42 to 76 years （ mean 59.1 years） received instrumented lumbar interbody fusion procedure using traditional posterior approaches for spondylolithesis with adjacent segment degeneration. Lumbar functions were assessed using Prolo system. Preoperative and follow-up lateral lumbar radiographs were studied for reduction of spondylolithesis, disc heights, lumbar lordosis, fusion rates and complications. [ Result] Fourteen patients were followed up, with an average duration of 28 （16 - 53） months. Clinical outcomes in terms of Prolo system was 7 points in 3 patients, 8 in 7 patients, 9 in 2 patients, and 4 in 2 patients at 3 months after operation with 85.7% being graded as good or excellent. Seven points in 4 patients, 8 in 6 patients, and 9 in 4 patients at last follow-up（ graded as 100% good or excellent）. Fusion rate was 66.7% （8/14） at 6 months and 92.9% （13/14） at 12 months after operation, Ten patients（71.4% ） fully recovered from spondylolithesis,4 had partial reduction, and their reduction status was unchanged according to plain radiographs at 12 months and last follow-up. The operative wound healed without complications in all patients. The mean Lordosis was 26.64° ± 6.67°, 33.29°± 3.39° and 32.71° ± 2.80°before and at 3- month ,or last follow-up after operation. The mean of fused Lordosis was 15.64° ±6.21°, 28.29° ± 3.28°and 32.36° ± 3.91 ° before at 6 months or at last time follow-up after operation. The dise heights were 6.54 ± 1.13mm and 9.62 ±0.81mm before and after operation. Statistics showed significant differenee （ P 〈 0.05 ）. [ Conclusion ] The morbidity and therapy of adjacent segment degeneration following spondylolithesis have its own characteristics. Double-level or many instrumentations for manag

关 键 词：腰椎滑脱 腰椎融合术 邻近节段退变 

分 类 号：R687.3[医药卫生—骨科学]