改良360°融合术治疗腰椎滑脱的疗效分析  

Clinical outcomes of modified 360° fusion for lumbar spondylolisthesis

作　　者：宋友东[1] 李书纲[1] 任志楠[1] 蔡思逸[1] 纪强 李志斌 许德荣[1] 

机构地区：[1]北京中国医学科学院北京协和医学院北京协和医院骨科,100730 [2]山东青岛市中心医院脊柱外科 [3]北京中国医学科学院整形外科医院外耳再造中心

出　　处：《中华骨科杂志》2014年第5期540-545,共6页Chinese Journal of Orthopaedics

摘　　要：目的总结改良360。融合术式治疗腰椎滑脱的临床疗效，探讨腰椎改良360。融合术的可行性及有效性。方法选取2005年3月至2012年11月期间采用改良360。融合术治疗单节段退行性腰椎滑脱患者76例的病历资料进行回顾性分析，男26例，女50例；年龄51～74岁，平均（64．3±7．8）岁。按Meyerding分级，Ⅰ度滑脱65例，Ⅱ度滑脱11例。腰痛伴下肢疼痛55例（72．3％），腰痛伴下肢麻木16例（27．7％），均有间歇性跛行的腰椎管狭窄症表现。合并椎间盘突出33例（43．4％），椎间盘膨出43例（56．6％），黄韧带增厚58例（76．3％），关节突增生内聚65例（85．5％），侧隐窝狭窄42例（55．3％）。融合器置于L3.4 者2例，L4.5者64例，L5S1者10例。术前、术后6个月及术后1年随访时采用视觉模拟评分（visualanaloguescale，VAS）及日本骨科协会（JapaneseOrthopaedicAssociation，JOA）评分对手术临床疗效进行评价。采用x线片及cT平扫加矢状重建评价融合及复位丢失情况。结果76例患者均获至少1年随访。滑脱手术复位率为96．8％；术后6个月复位丢失率为1．1％，术后1年为0．8％，差异无统计学意义。术前与术后及末次随访时滑脱率、腰椎前凸角度、椎间盘高度、滑脱角度的差异均有统计学意义，而术后1周、6个月及1年的差异均无统计学意义。术后6个月植骨融合率为76．3％，术后1年为98．7％，差异有统计学意义。末次随访时JOA评分和VAS评分与术前比较差异均有统计学意义。术中硬脊膜撕裂1例；术后融合器沉降1例，螺钉松动1例。结论改良360。融合术治疗腰椎滑脱疗效确切，复位丢失率低，植骨融合率高，值得临床推广。Objective To analyze the clinical results of 360° fusion for spondylolisthesis. Methods Data of 76 patients from March 2005 to November 2012, including 26 males and 50 females with a mean age of 54.3 years were retrospectively ana- lyzed. All patients had undergone modified 360° fusion. The clinical outcomes were evaluated by the Japanese Orthopaedic Associ- ation scores （JOA） and visual analogue scale （VAS）. The fusion status and loss of correction were assessed by CT and plain radio- graphs. Results All patients had been successfully followed up for at least one year. Post-operative reduction rate was 96.8%, with a mean loss rate of 1.1% at six months and 0.8% at one year follow-up separately, but the difference was not significant. Post- operative percentage of slip, lumbar lordosis, intervertebral disc height and slip angle had significant differences, compared with those of the pre-operative, but the difference between one week post-operative, six months follow-up and one year follow-up were not significant. The fusion rate was 76.3% at six months follow-up and 98.7% at one year follow-up, and there were significant dif- ferences. Both JOA and VAS score at six months and one year follow-up indicated significant differences in contrast to that of pre- operative. Dural injury was found in one patient, and subsidence was found in one patient. One received a second operation at 3 months after the surgery due to screw loose. Conclusions Modified 360° fusion shows great clinical outcome and fusion rate, which can be a dominant procedure for treating soondvlolisthesis.

关 键 词：腰椎 脊椎前移 脊柱融合术 治疗结果 

分 类 号：R687.3[医药卫生—骨科学]