双侧下关节突切除及椎间融合治疗退变性腰椎管狭窄症的疗效分析  

Both inferior articular process excision and interbody fusion treatment for lumbar spinal stenosis of retrograde degeneration

作　　者：曹俊明[1] 杨大龙[1] 申勇[1] 丁文元[1] 徐佳欣[1] 张迪[1] 杨柳[1] 

机构地区：[1]河北医科大学第三医院脊柱外科,石家庄050051

出　　处：《中国矫形外科杂志》2010年第15期1258-1261,共4页Orthopedic Journal of China

摘　　要：[目的]评价腰后路全椎板及双侧下关节突切除减压,自体小关节骨质及Cage椎间植骨融合椎弓根内固定治疗退变性腰椎管狭窄症的手术疗效。[方法]41例患者(男23例,女18例);平均60.3岁,行腰后路全椎板及双侧下关节突切除减压,自体小关节骨质及Cage椎间植骨融合椎弓根内固定手术,平均随访31.5个月,评价其术前及术后随访时JOA评分、手术效果、放射学结果及手术并发症。[结果]术后无内固定物松动、断裂等并发症发生。随访时植骨融合率97.56%,1例患者有腰椎不稳征象。随访时JOA评分较术前有明显提高(P<0.01),临床优良率为90.24%。手术并发症包括2例硬脊膜撕裂,1例椎弓根位置偏斜,1例假关节形成。[结论]腰后路全椎板及双侧下关节突切除减压,自体小关节骨质及Cage椎间植骨融合椎弓根内固定手术治疗退变性腰椎管狭窄症具有良好的临床疗效。[ Objective ] To evaluate the operation curative effect of posterior vertebral plate and both inferior articular process excision decompression, and lumbar interbody fusion using local facet joint autograft and cage additional of pediele screw intemal fixation treatment for lumbar spinal stenosis of retrograde degeneration. [ Methods] Forty -two patients （average age, 60. 3 ） with lumbar spinal stenosis of retrograde degeneration were treated operatively with posterior vertebral plate and both inferior articular process excision decompression, and lumbar interbody fusion using local facet joint autograft and cage additional of pedicle screw internal fixation. After an average follow - up of 36. 5 months, the changes in the JOA Scores of pre - and post - operation, the radiographic findings and complications were evaluated. [ Results ] There were no internal fixation loosing or breaking at postoperation. The postoperative JOA improved significantly than preoperative （ P 〈 0.01 ） . Good radiographic fusion （97. 56% ） and clinical results （ the clinical excellent and good rates were 90. 24% ） was achieved. Complications included dural tear （ n = 2） , pedicle screw deviating （ n = 1 ） , lumbar unsteadiness （ n = 1 ） and bony nonunion （ n = 1 ） . [ Conclusion ] Satisfactory clinical curative effect could be obtained by lumbar posterior vertebral plate and both inferior articular process excision decompression, and lumbar interbody fusion using local facet joint autograft and cage additional of pedicle screw internal fixation for lumbar spinal stenosis of retrograde degeneration.

关 键 词：腰椎管狭窄症 退变 椎间融合 小关节 

分 类 号：R687.3[医药卫生—骨科学]