不同节段椎弓根钉置入脊椎内固定治疗腰椎滑脱(英文)  

Surgical treatment of lumbar spondylolisthesis using short or long segment pedicle screw fixation

作　　者：沈宁江[1] 王先安[1] 林庆彪[1] 陈建[1] 李一波[1] 

机构地区：[1]海南省人民医院脊柱关节外科,海南省海口市570311

出　　处：《中国组织工程研究》2012年第9期1569-1572,共4页Chinese Journal of Tissue Engineering Research

摘　　要：背景:对椎弓峡部裂腰椎滑脱、退行性腰椎滑脱的治疗,到底是采用短节段固定还是长节段固定争论很多。目的:观察短节段或长节段椎弓根钉内固定治疗腰椎滑脱的临床疗效。方法:腰椎滑脱患者146例,男36例,女110例,年龄22～73岁,平均53岁,病程1～18年,平均5年。采用腰椎管扩大开窗减压或全椎板切除减压、短节段或长节段椎弓根螺钉复位内固定、横突间或椎体间植骨融合。结果与结论:146例患者中采用短节段4枚椎弓根螺钉固定72例,长节段6枚椎弓根螺钉固定74例。椎间植骨101例,横突间植骨45例。术后随访134例,随访时间1.5～14年,按Steffee临床疗效分级标准,优74例,良41例,中13例,差6例,优良率85.8%。完全复位77例,其中短节段固定32例,长节段固定45例;部分复位69例,其中短节段固定40例,长节段固定29例。短节段固定者有8例13枚椎弓根螺钉发生断裂,而长节段固定者未发生椎弓根螺钉断裂。分析患者腰椎滑脱的类型、程度、病程长短、是否合并相邻节段椎间盘退变、不稳等情况,是选择用短节段还是用长节段置入固定的依据。BACKGROUND： There are a lot of controversies regarding the choice of short versus long segment pedicle screw fixation for the treatment of isthmic spondylolisthesis and degenerative spondylolisthesis treatment. OBJECTIVE： To investigate clinical efficacy of short versus long segment pedicle screw fixation in treatment of lumbar spondytolisthesis. METHODS： A total of 146 spondylolisthesis patients were included in this study, 36 males and 110 females, aged 22-73 years at a mean of 53 years; disease duration was from 1 to 18 years at a mean of 5 years. These patients were treated with lumbar spinal window-opened decompression or laminectomy decompression, a short or long segment pedicle screw internal fixation, transverse interbody fusion. RESULTS AND CONCLUSION： Among 146 involved patients, 72 cases were treated with four pedicle screw fixation （short segments）, while 74 cases with six pedicle screw fixation （long segments）. Interbody graft was performed in 101 cases, while intertransverse fusion given in 45 cases. Totally 134 cases were followed up for postoperative 1.5 14 years. According to clinical grading standards of Steffee system, the clinical efficacy was assayed excellent in 74 cases, good in 41 cases, mild in 13 cases and poor in 6 cases, with good rate of 85.8%. 77 cases achieved a complete reduction, including 32 cases using a short segment fixation and 45 cases using a long segment fixation. 69 cases achieved partial reduction, including 40 cases using a short segment fixation and 29 cases using a long segment fixation. Pedicle screws ruptures were found in 13 screws of eight patients undergoing short segment fixation, while no pedicle screw fracture was found in long segment fixation. Choice of short or long segment for the fixation is based on the analysis of spondylolisthesis type, severity, duration of disease, emergence of adjacent segment disc degeneration and instability.

关 键 词：腰椎滑脱 椎弓根钉 内固定 节段 植骨融合 

分 类 号：R318[医药卫生—生物医学工程]