椎弓根螺钉固定小关节融合术治疗Ⅰ度腰椎滑脱临床效果评价  

Clinical effect of instrumented facet fusion using pedicle screws for grade I lumbar spondylolisthesis

作　　者：韩世杰[1] 仉建国[1] 邱贵兴[1] 范彧[1] 杨新宇[1] 赵丽娟[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院骨科,北京100730

出　　处：《中国骨与关节外科》2011年第4期294-299,共6页Chinese Journal of Bone and Joint Surgery

摘　　要：目的评价椎弓根螺钉固定小关节融合术治疗Ⅰ度腰椎滑脱的临床效果。方法回顾性分析2005年10月至2008年7月收治的35例单节段Ⅰ度腰椎滑脱行小关节融合患者的临床资料。其中男性8例,女性27例;年龄27～88岁,平均年龄61.1岁。术前和末次随访时采用VAS、ODI评分进行临床评价,融合情况采用X线片及CT平扫并矢状位重建进行评价。结果 35例患者均获随访,随访时间14～48个月,平均25.4个月。术后滑脱复位率为75.8%,术前、术后及末次随访的滑脱率比较差异均有统计学意义(P=0.000);末次随访VAS和ODI评分与术前比较差异均有统计学意义(P=0.000)。末次随访患者主观优良率为94.3%。X线片和CT评价融合率分别为94.3%和97.1%。并发症有出现退变性侧凸2例(分别在术后15和17个月随访时发现),术后14个月出现上方邻近节段后滑脱1例,术后早期出现伤口延迟愈合行清创术1例。结论椎弓根螺钉固定小关节融合术治疗Ⅰ度腰椎滑脱是一种简单易行的手术方式,其融合率及手术效果满意。Objective To evaluate the clinical effect of instrumented facet fusion using pedicle screws for gradeⅠlumbar spondylolisthesis.Methods From October 2005 to July 2008,35 patients（mean age 61.1 years,27～88） with single-level gradeⅠlumbar spondylolisthesis operated with facet fusion,including 8 males and 27 females,were reviewed retrospectively.The clinical outcomes were evaluated using the Oswestry disability index（ODI） and pain index （VAS）.The fusion status were assessed using plain dynamic radiographs and CT.Results All the 35 patients got complete follow-up,the average follow-up was 25.4（14～48） months.The reduction rate was 75.8%.The percentage of slip before and after surgery,and at the final follow-up showed significant difference（P〈0.05 ） when compared with each other;VAS and ODI at the final follow-up was significantly improved（P〈0.05 ）.The subjective rate of ＇ much bet- ter＇ and ＇ better＇ was 94.3%.The fusion rate of X-ray and CT is 94.3%and 97.1%.The complications included 2 cases with degenerative scoliosis at 15 and 17 month follow-up,1 case with proximal adjacent segment retrolisthesis at the 14 month follow-up,1 case with postoperative delayed union cured after debridement.Conclusion Instrumented facet fusion using pedicle screws showed good clinical results and high fusion rate in the treatment of gradeⅠlumbar spondylolisthesis, long-term follow-up is need for further evaluation.

关 键 词：腰椎滑脱 脊柱融合术 小关节融合术 治疗结果 

分 类 号：R687.3[医药卫生—骨科学]