环锯法椎体间加压植骨融合治疗腰椎滑脱  

Posterior interbody fusion with circular saw for treatment of lumbar spondylolisthesis

作　　者：郑远华 张伟 李源 

机构地区：[1]河南省商丘市中心医院,476000

出　　处：《中国矫形外科杂志》2009年第19期1466-1468,共3页Orthopedic Journal of China

摘　　要：[目的]寻找一种既能使椎体间植骨牢固融合,又能使手术操作简便安全并发症少的椎间融合方法。[方法]后正中入路脊髓神经根彻底减压后,用直径1.0 cm环锯摘除滑脱椎体间的椎间盘,然后通过环锯孔直视下彻底清除椎间盘髓核组织,用长柄刮匙刮除椎体上下终板软骨,使骨面成鱼鳞状。椎弓根钉棒系统固定后,用直径1.2cm环锯在髂后上棘上端髂嵴处取髂骨植入椎间隙,然后调整钉棒系统,使其椎间隙适当缩小,植入椎体间及嵌入封口的髂骨块挤压牢固后,将钉棒系统固定。[结果]本组48例患者术后均随访6～24个月,临床融合率100%,临床疗效,根据JOA下腰疼评分标准,优36例,良8例,中4例,优良率91.67%,有效率100%。[结论]应用环锯取骨植骨法,有以下3大优点:(1)手术视野大,椎间盘摘除彻底,既可避免摘除椎间盘时损伤重要组织,又易于构建良好的植骨床,有利于植骨融合;(2)取骨方便、安全、损伤小、出血少,既缩短了手术时间,又避免了取骨处并发症的发生,本术式平均手术用时90 min,出血量<200 ml;(3)植骨融合率高,术后效果好。[ Objective ] To modify posterior lumbar interbody fusion for improvement of convenient manipulation and safety in the operation, and solid fusion. [ Methods ] After total decompression of the spinal nerve through posterior medline ap- proach, discectomy of the slipping segment was performed with a circular saw with diameter of 1.0 centmeter. Under direct visu- alization through the hole of the circular saw, the disc tissue including cartilage of upper and lower end plates was removed with a long.handle curette. After pedicle screw and rod system was placed, a bone block harvested from the posterosuperior iliac with a circular saw with diameter of 1.2 centmeter was implanted into the intervertebral space. Then compression of the intervertebral space to catch the bone lock firmly was conducted by regulating and fixing the the pediele screw and rod system. [ Results Forty - eight patients in this report were followed up from 6 to 24 months. Based on JOA low back pain score, there were 36 pa- tients was in excellent result, 8 in good and 4 in fair, the satisfactory rate was 91.67% and effective rate was 100%. [ Conclu- sion] Using circular saws in posterior lumbar interbody fusion has advantagas of good visualization profit removing disc tissue, preventing neurovascular injuries, and making good bone grafting bed. Convenient and secure bone harvesting decrease blood loss, time consume during the operation and prevent donor site complication. Futhermore, follow up results of the patients in this report demonstrate that posterior interbody fusion with circular saw for treatment of lumbar spondylolisthesis have satisfactory out- come and high fusion rate.

关 键 词：腰椎 脊柱滑脱 后路椎体间融合术 环锯 

分 类 号：R687.3[医药卫生—骨科学]