插入型椎间融合器在老年腰椎滑脱症患者中的应用  

The clinical application of insert cage in posterior lumbar interbody fusion for spondylolisthesis in aged patients

作　　者：王大林[1] 曾逸文[1] 王黎明[1] 吴小涛[2] 蒋纯志[1] 桂鉴超[1] 徐杰[1] 王钢锐[1] 郑圣鼐[1] 费俊良[1] 

机构地区：[1]南京医科大学附属南京第一医院脊柱外科中心,南京市210006 [2]东南大学附属中大医院骨科,南京市210009

出　　处：《中国脊柱脊髓杂志》2009年第6期421-426,共6页Chinese Journal of Spine and Spinal Cord

摘　　要：目的:评估插入型椎间融合器在老年腰椎滑脱症患者手术治疗中的应用效果。方法:自2001年3月至2006年2月应用全椎板减压、插入型椎间融合器撑开复位、椎弓根钉棒系统补充复位和固定治疗老年腰椎滑脱症患者36例,男25例,女11例,年龄60～72岁,平均64.7岁。所有病例进行定期随访和影像学检查,对椎间隙高度、椎间孔高度、滑脱距离、滑脱率、滑脱角及临床Oswestry功能障碍评分进行测量和评估,并观察椎间融合情况。结果:21例置入融合器后达到复位或基本复位,15例通过提拉螺钉进行补充复位。术中硬脊膜撕裂3例,1例裂口较小,术中未予处理;2例裂口较长,术中缝合后以脑棉片覆盖,紧密缝合腰背筋膜及皮肤切口,术后采取去枕头低脚高位,未见脑脊液漏出。术后出现神经根刺激症状2例,予以脱水、营养神经治疗,均恢复满意,未遗留神经症状。术后所有患者滑脱节段生理曲度恢复,椎间隙高度由术前4.5±0.6mm增加至术后9.8±1.5mm,椎间孔高度由术前9.9±1.0mm增加至术后13.2±1.2mm,滑脱角由术前25.1°±8.2°改善至术后15.8°±2.5°,术后与术前相比差异均有统计学意义(P<0.01)。随访15～76个月,平均34.5个月,矫正程度无明显丢失。33例融合成功,融合率91.7%。Oswestry功能障碍评分由术前35.4±5.2分降至术后19.5±4.8分,术后优良率及末次随访优良率分别为87.3%及92.5%。结论:采用后路腰椎椎体间融合术治疗老年腰椎滑脱症时应用插入型椎间融合器可发挥撑开复位和融合的双重作用,安全有效。Objective：To evaluate the role of insert cage in reduction and fusion in posterior lumbar interbody fusion （PLIF） for spondylolisthesis in aged patients.Method：The clinical outcomes and radiological data was assessed retrospectively in a series of 36 patients with spondylolisthesis in aged patients who underwent surgical treatment from March 2001 to February 2006.The study group consisted of 25 males and 11 females aged 60-72 years （average 64.7 years ） .Surgical procedure was modified,and the definitive reduction of the spondylolisthesis was made by insert cages augmented with pediele screw instrumentation after deeompressive lamineetomy.The clinical outcomes were detei^nined by Oswestry disability questionnaire and the radiographic evaluation including height of intervertebral disc and forameu,slipping degree,and slipping angle.Result：In 21 cases the slips were completely or partially reduced after inserting the cage,however,in other 15 cases complemental reduction of the slip by pedicle screw was needed.Dural sac laceration occured in 3 cases,one was dural sac fissure,no repairing was needed,other 2 cases were long lacerated wound,which were sutured properly,then lumbodorsal fascia was tightly closed.The patients underwent trendelenburg position after operation, no leakage of cerebrospinal fluid was found postoperatively.There were 2 cases with neurological deficit,dehydration and nerve nourishment were performed,and result was satisfied without remaining of any neurological deficit.All cases of the slipping degree were reduced and the normal sagital plane alignment were restored. The height of intervertebral disc and foramen,and slip angle before and after operation were 4.5±0.6mm and 9.8±l.5mm,9.9±1.0mm and 13.2±1.2mm,25.1°±8.2°and 15.8°±2.5° respectively,there were all signifieantly dif ferences in the height of intervertebral disc and foramen,and slip angle between pre- and post-operation respectively （P〈0.01）.The radiographic data showed no obvious loss of the correction in a

关 键 词：腰椎 脊椎滑脱症 脊柱融合术 骨移植 

分 类 号：R681.5[医药卫生—骨科学]