局部减压骨行椎体间植骨融合对不同节段腰椎管狭窄症效果  

LOCAL DECOMPRESSION BONE FOR INTERVERTEBRAL FUSION IN THE TREATMENT OF DIFFERENT-SEGMENT LUMBAR SPINAL STENOSIS

作　　者：袁昌振[1] 周传利[1] 徐海燕[1] 刘超[1] 柯增光[1] 王德春[1] 

机构地区：[1]青岛大学医学院附属医院脊柱外科,山东青岛266003

出　　处：《青岛大学医学院学报》2014年第1期31-33,36,共4页Acta Academiae Medicinae Qingdao Universitatis

摘　　要：目的 比较应用局部减压骨行椎体间植骨融合治疗不同节段椎管狭窄症的效果,探讨局部减压骨应用于多节段椎体间融合的可行性。方法 回顾性分析退变性腰椎管狭窄症病人52例的临床资料,其中单节段23例,双节段13例,多节段16例。术中经腰椎后路切除狭窄腰椎大部分椎板、黄韧带,保留上1/3椎板,彻底减压中央管、神经根管及椎间孔,从症状侧切除椎间盘,处理上下终板,将切除的棘突、椎板及关节突等修整成颗粒骨（直径约3 mm）植于椎体间,行椎弓根螺钉内固定。所有病人术后随访12～36个月,平均26个月,术前及末次随访时采用视觉模拟评分（VAS）、Oswestry功能障碍指数（ODI）及简明健康调查表（SF-36）评价临床疗效;拍摄腰椎X线片,测量手术前后腰椎前凸度、受累椎间隙角度及椎间高度,并观察植骨融合状况。结果 术后末次随访,单节段、双节段及多节段腰椎管狭窄病人VAS、ODI及SF-36评分差异无显著性（P〉0.05）,骨融合率差异无显著性（P〉0.05）;多节段组腰椎前凸度、受累椎间隙角度及受累椎间高度与单节段、双节段组相比明显变小,差异有显著意义（F=4.244～9.377,P〈0.05）。结论 应用局部减压骨行椎体间植骨融合治疗不同节段椎体间椎管狭窄症效果可靠,但在多节段椎体间植骨融合术中支撑作用较小。Objective To assess the efficacy of using local bone for intervertebral fusion （IF） in the treatment of diffe- rent-segment lumbar spinal stenosis （LSS）, and explore its feasibility for multi segment IF. Methods A retrospective analysis was done of clinical data of 52 patients with degenerative lumbar spinal stenosis, including 23 cases with one-segment, 13 with two- segment and 16 with multi-segment stenosis. A posterior lumbar approach was performed. Most narrowed lamina of lumbar verte- brae and ligamenta flava were resected, and 1/3 of upper lamina reserved. The central canal and nerve root canal were decom pressed completely, and the disc was removed from the symptomatic side. The resected spinous processes, lamina and articular processes were trimmed to particle bone （about 3mm in diameter） for intervertebral bone grafting and pedicle screw fixation done. All the patients were followed for （mean） 12-36 （26） months. During the preoperative and the last follow-up, visual analogue scale （VAS）, Oswestry dysfunction index （ODI） and simple health questionnaires （SF-36） were used to assess the clinical efficacy; a lumbar X-ray was taken, the degree intervertebral angle and the of intervertebral height were measured, and the fusion of bone graft observed. Results At the final follow up after surgery, the VAS, ODI and SF-36 score in the patients with one-, two-and multi-segment lumbar stenosis was not significantly different （P〉0.05）, the bone fusion rate was also no significant difference （P〉0.05）. In multi-segment group, the intervertebral angle and intervertebral height were reduced as compared with both one-and two-segment stenosis groups （F=4.244-9.377,P〈0.05）. Conclusion The effectiveness of local bone for intervertebral fusion in the treatment of different-segment spinal canal stenosis is reliable, while for multi-segment stenosis the supporting is weaker.

关 键 词：腰椎 手术减压 骨移植 椎体融合 椎管狭窄 

分 类 号：R687.3[医药卫生—骨科学]