融合修复双节段腰椎滑脱:椎间高度与骨盆倾斜角及骶骨倾斜角的随访  

Fusion for treating double-segment lumbar spondylisthesis: follow-up evaluation of lumbar height, pelvic tilt angle and sacral slope angle

作　　者：杨思振[1] 马进峰[1] 王德春[1] 

机构地区：[1]青岛大学附属医院脊柱外科,山东省青岛市266000

出　　处：《中国组织工程研究》2015年第9期1382-1387,共6页Chinese Journal of Tissue Engineering Research

摘　　要：背景:后路腰椎椎间融合内固定术目前在临床上已成熟应用于治疗单节段的腰椎滑脱症,目前针对于双节段腰椎滑脱的研究相对较少。目的:探讨腰椎后路椎间融合治疗双节段腰椎滑脱的疗效。方法:双节段腰椎滑脱患者20例,均采用腰椎后路椎间融合治疗,即后路腰椎管减压、神经根松解、椎体间植骨融合、椎弓根螺钉系统复位固定治疗。固定前1 d、固定后1周,固定后3,6个月及固定后1年并以后每隔一年均行腰腿痛目测类比评分,使用Oswestry功能障碍指数问卷调查表评价临床功能恢复情况,并通过影像学检查观察滑脱恢复情况、椎间高度、骨盆倾斜角、骶骨倾斜角和植骨融合情况,综合评价临床疗效。结果与结论:患者20例均获随访,随访时间6个月至3年,目测类比评分及Oswestry功能障碍指数得分固定后及末次随访较固定前降低(P<0.05);固定后及末次随访时椎间隙高度均较固定前明显增高(P<0.05),固定后及末次随访时滑移百分率、骨盆倾斜角及骶骨倾斜角均较固定前有所改善(P<0.05),无内固定松动或断钉断棒,所有病例复位满意,所有患者植骨融合良好,无假关节形成。结果证实,后路腰椎椎间融合内固定治疗双节段腰椎滑脱效果满意,该术式具有复位良好,固定牢靠,融合率高等优点并可重建脊柱-骨盆矢状面正常的生理序列,增加脊柱稳定性。BACKGROUND：Posterior lumbar interbody fusion with pedicle screws has been applied maturely in treating single-level lumbar spondylisthesis. However, little evidence has focused on the application of this operation in treatment of double-segment lumbar spondylolisthesis. OBJECTIVE：To investigate the clinical efficacy of posterior lumbar interbody fusion with pedicle screws in treatment of double-segment lumbar spondylolisthesis. METHODS：Twenty patients with double-segment lumbar spondylolisthesis were treated with posterior lumbar interbody fusion with pedicle screws, including posterior lumbar-spinal canal decompression, nerve root release, interbody graft fusion, pedicle screws reduction and fixation. Clinical functional recovery was assessed by Oswestry disability index and visual analog scale. Radiographic data including lumbar slippery percentage, lumbar slippery angle, lumbar height, pelvic tilt angle and sacral slope angle were measured. Al data was col ected 1 day before surgery, 1 day, 3 months, 6 months and 1 year after surgery, and every year constantly. RESULTS AND CONCLUSION：Al 20 patients were fol owed up for 6 months to 3 years. Oswestry disability＆nbsp;index and visual analog scale were lower after surgery and at the final fol ow-up, when compared with before surgery （P〈0.05）. Lumbar disc height was significantly increased after surgery and at the final fol ow-up, than those of pre-operation （P〈0.05）. Lumbar slippery percentage, pelvic tilt angle and sacral slope angle were improved significantly after surgery and at the final fol ow-up, when compared with before surgery （P〈0.05）. During the fol ow-up, there were no signs of rupture, loosing or fal ing in the internal fixation and no pseudarthrosis. Reposition and reliable fusion of the bone graft were achieved satisfactorily in al patients. Al patients are satisfactory of posterior operation with pedicle screw internal fixation, reduction, decompression in treating double-segment lumbar spondylolisthesis, due to s

关 键 词：组织工程 腰椎 椎间盘 植入物 脊柱植入物 双节段 腰椎滑脱 椎间融合 固定治疗 椎间隙高度 滑移百分率 滑脱角 骨盆倾斜角 骶骨倾斜角 椎弓根螺钉 

分 类 号：R318[医药卫生—生物医学工程]