后路减压内固定联合植骨融合术治疗老年腰椎滑脱并椎管狭窄的临床疗效分析  

The analysis of the posterior decompression and internal fixation and bone grafting in elderly lumbar spondylolisthesis combined with spinal stenosis

作　　者：张世华[1] 李祥[1] 钱本俄 汤建华[1] 王晓燕[1] 章志祥[1] 张金林[1] 张世旭[1] 

机构地区：[1]云南省曲靖市第一人民医院骨创伤科,655000

出　　处：《临床合理用药杂志》2015年第4期29-31,共3页Chinese Journal of Clinical Rational Drug Use

摘　　要：目的：探讨后路减压、椎弓根钉固定、横突间植骨联合Cage椎间植骨融合术治疗老年性腰椎滑脱并椎管狭窄的手术方法及其疗效。方法对老年性腰椎滑脱并椎管狭窄患者47例均施行后路减压、椎弓根钉固定、横突间植骨联合Cage椎间植骨融合术。观察手术时间、出血量、并发症情况，随访复位情况。结果手术时间110～245（121．0±30．1）min；失血量278～1200（415±75．2）ml。单纯硬脊膜撕裂2例，术中给予修补。术后卧床期间并发肺部感染1例，给予治疗后痊愈。47例患者均获得随访，随访时间12～36（21．5±9．8）月，术后1年X线片显示47例滑脱复位满意，Ⅰ度滑脱者8例复位达100％（8／8），Ⅱ度滑脱者33例复位达90．9％（30／33），Ⅲ度滑脱者6例复位达66．7％（4／6）。47例中钉棒系统位置满意，Cage无下沉及移位。椎旁植骨融合中，有3例不融合。术前JOA评分8～15（12．3±2．6）分；术后JOA评分19～26（23．1±3．2）分；改善率57％～84％，平均改善率（71．3±6．8）％。结论后路减压、椎弓根钉固定、横突间植骨联合Cage椎间植骨融合术治疗老年性腰椎滑脱并椎管狭窄疗效肯定。Objective To analysis the clinical effect of posterior decompression and internal fixation and bone grafting in elderly lumbar spondylolisthesis combined with spinal stenosis. Methods Selected 47 cases patients with elderly lumbar spondylolisthesis and spinal stenosis, addopted posterior decompression, pedicle fixation, posterolateral graft interbody fusion joint cage,lumbar spondylolisthesis, spinal stenosis. Observe the Operation time, blood loss, complications, follow-reattachment. Results The operation time was （ 121± 30.1 ） min, blood loss was 278 - 1200 （415± 75.2） ml. 2 cases of dural tear alone, re- paired by surgery. One case of lung infection, recovered after treatment. 47 patients were followed up, 12 - 36 （ 21.5± 9.8 ） months follow-up period. 1 year after X ray showed 47 cases of spondylolisthesis satisfaction. I spondylolisthesis were all reset （ 8/8 ）.Ⅱ degree spendylolisthesis were 33 cases, reset up 90.9% （30/33）. Three were six cases of spondylolisthesis, reset up 66.7% （4/6）. In 47 cases of pedicle screw position satisfaction, Cage without sinking and displacement. 3 cases of nonunion paraspinal. Preoperative JOA score 8 ～ 15 （ 12.3 ± 2.6） score, postoperative JOA score was 19 ～ 26 （21.3± 3.2） score. Im- provement rate of 57% to 84%. The average improvement rate was（73.1 ± 6.8）%. Conclusion Posterior decompression and internal fixation and bone grafting in elderly lumbar spondyiolisthesis combined with spinal stenosis has an good effect.

关 键 词：腰椎滑脱 椎管狭窄 后路减压 内固定术 脊柱融合术 老年 

分 类 号：R687.3[医药卫生—骨科学]