椎板重建在腰椎滑脱症手术治疗中的应用  

Postlaminectomy vertebral lamina reconstruction and pedicle screw reduction and fixation for lumbar spondylolis-thesis

作　　者：赵永生[1] 林勇[1] 历强[1] 

机构地区：[1]青岛市市立医院东院区骨科脊柱病区,山东青岛266071

出　　处：《中国骨伤》2012年第6期478-481,共4页China Journal of Orthopaedics and Traumatology

摘　　要：目的:探讨椎管减压椎弓根钉复位固定椎间植骨加椎板重建术治疗腰椎滑脱症的临床疗效。方法:自2007年8月至2008年8月,选择32例腰椎滑脱症患者行全椎板切除椎管减压椎弓根钉复位固定椎间植骨术,然后在椎板切除减压区硬膜外植微粒骨重建椎板,其中26例获得1年以上随访,男16例,女10例;年龄55～76岁,平均62.5岁;病程2～10年。所有病例术前有不同程度的腰痛,一侧或双下肢麻木、疼痛、间歇性跛行等。影像学检查为L3、L4或L5的Ⅰ-Ⅲ度前滑脱,其中退行性滑脱18例,峡部裂性滑脱8例。术后3个月及末次随访时从临床症状体征改善程度、滑脱椎体复位情况、植骨融合情况及椎管狭窄情况等方面对疗效进行评定。结果:26例患者平均随访时间为1年8个月(1～3年)。术后切口均愈合良好,无并发症发生。临床改善情况按JOA下腰痛评分标准,术前为(5.2±1.5)分,术后3个月为(23.1±1.9)分,优20例,良5例,可1例;末次随访评分(22.9±2.4)分,优19例,良5例,可2例。术后3个月和末次随访JOA评分较术前有明显改善(P=0.00),术后3个月和末次随访时疗效无明显差异(P>0.05)。滑脱椎体复位情况:Ⅰ度滑脱的17例完全复位;Ⅱ度滑脱的7例中5例完全复位,2例改善为Ⅰ度;Ⅲ度滑脱的2例改善为Ⅰ度。植骨融合情况:术后3个月20例融合,末次随访时全部融合,重建椎板骨质大片融合形成替代椎板。椎管狭窄情况:术后3个月及末次随访时CT检查示椎管无狭窄,神经根、硬膜囊无压迫。结论:椎管减压椎弓根钉复位固定椎间植骨加椎板重建术治疗腰椎滑脱症可以同时达到椎体复位、充分减压和脊柱生物力学稳定,能有效预防术后腰椎不稳以及瘢痕压迫、粘连等形成的医源性椎管狭窄,早期及中期疗效满意,为腰椎滑脱症的治疗提供了另外思路。Objective：To investigate the clinical effects of spinal canal decompression and pedicle screw reduction and fixation, and intervertebral bone grafting fusion for the treatment of lumbar spondylolisthesis associated with nerve compression symptoms. Methods：Postlaminectomy vertebral lamina reconstruction and pedicle screw reduction and fixation were per- formed in 32 patients with lumbar spondylolisthesis between August 2007 and August 2008. Of them, 26 patients were followed up for more than 1 year,including 16 males and 10 females who ranged in age from 55 to 76 years （mean 62.5 years）. The course of disease was 2-10 years. All patients had low back pain, numbness and pain in one or both lower extremities and in- termittent claudication symptoms. Radiograms showed L3L, or Ls anter-olisthesis of Ⅰ to Ⅲ degree. There were 18 cases of re- gressive olisthesis and 8 cases of spondylolysis. The clinical improvement,the vertebral reduction, the lamina fusion rate and canal stenosis state were observed and assessed. Results ：The wounds healed well in all 26 cases without occurrence of signifi- cant complications. Clinical improvement was assessed according to the JOA lower back pain score scale. The mean preopera- tive score was 5.2±1.5 ,and 23.1±1.9 at 3 months after operation. The result was excellent in 20 cases,good in 5 cases ,and fair in l case. The mean score on the last followed-up was 22.9±2.4, and the result was excellent in 19 cases, good in 5 cases, and fair in 2 cases. JOA score at 3 months after operation and that at the last followed-up were significantly different from that be- fore operation （P=0.00） ,and there was no significant difference between JOA score at 3 months after operation and that at the last followed-up （P〉0.05）. Complete reduction was achieved in 17 degree Ⅰ case and 5 degree Ⅱ cases. Two degree Ⅱ cases were improved to degree Ⅰ, and 2 degree Ⅲ cases were improved to degree Ⅰ. Vertebral fusion was achieved 3 months after op- eration in 20 cases, and

关 键 词：腰椎 脊椎滑脱 椎管狭窄 椎板切除术 

分 类 号：R681.5[医药卫生—骨科学]