单枚长方形cage椎间融合联合椎弓根螺钉固定治疗峡部裂性腰椎滑脱症  

Single rectangle cage interbody fusion combined with pedicle screw fixation in treatment of isthmic spondylolisthesis

作　　者：侯海涛[1] 邵诗泽[1] 王亚楠[1] 黄相鹏[1] 付松[1] 

机构地区：[1]山东省文登整骨医院脊柱脊髓科,文登264400

出　　处：《中华骨科杂志》2016年第13期849-854,共6页Chinese Journal of Orthopaedics

摘　　要：目的：探讨单枚长方形cage椎间融合联合椎弓根螺钉固定治疗峡部裂性腰椎滑脱症的疗效。方法回顾性分析2012年3月至2015年2月采用后路单枚长方形cage椎间融合联合椎弓根螺钉固定治疗34例峡部裂性腰椎滑脱症患者资料，男21例，女13例；年龄18~63岁，平均（41.6±8.2）岁；L4滑脱15例，L5滑脱19例；MeyerdingⅠ度12例，Ⅱ度16例，Ⅲ度6例；腰痛伴下肢疼痛28例，腰痛伴下肢麻木19例，腰痛伴下肢肌力减退18例，大小便障碍2例。对手术时间、术中出血量、术后引流量、植骨融合及并发症进行观察，并对手术前后的椎间隙高度、日本矫形外科协会（Japanese Orthopaedic Association, JOA）评分、Oswestry功能障碍指数（Oswestry disability indes, ODI）评分、视觉模拟评分（visual analogue scale, VAS）进行比较。结果34例患者均顺利完成手术，平均手术时间（1.8±0.8）h，平均术中出血量（362.4±93.7）ml，平均术后引流量（116.3±54.2）ml。所有患者均获得随访，随访时间12~46个月，平均1年10个月。术后2周L4，5、L5S1椎间隙高度[（9.85±1.11）mm、（9.63±1.04）mm]，较术前[（6.53±0.98）mm、（6.24±1.07）mm]明显增高，差异有统计学意义；末次随访时高度略丢失[（9.23±1.33）mm、（9.30±1.16）mm]，与术后2周比较，差异无统计学意义。末次随访时，JOA评分为（13.19±1.08）分、ODI评分为（12.34±7.52）分、VAS评分为（2.23±1.51）分，与术前比较差异均有统计学意义；患者腰痛、下肢神经症状及生活质量均较术前明显改善。术后16个月，X线片示所有患者椎体间植骨均骨性融合。末次随访时，无一例发生椎弓根螺钉松动、断裂情况。结论采用单枚长方形cage椎间融合联合椎弓根螺钉固定治疗峡部裂性腰椎滑脱症是一种创伤小、出血少、安全、有效的手术方式。Objective To explore the effects of single rectangle cage interbody fusion combined with pedicle screw fixa？tion for isthmic spondylolisthesis. Methods Data of the 34 cases with isthmic spondylolisthesis hospitalized at our department from March 2012 to February 2015 were retrospectively analyzed. All cases were operated by posterior pedicle screw fixation com？bined with single rectangle cage interbody fusion. There were 21 males and 13 females, aging from 18 to 63 years old （with an aver？age age of 41.6±8.2 years）. Lesion segments were L4 in 15 cases and L5 in 19 cases;there were 12 cases in Meyerding I degree, 16 in II degree and 6 in III degree;28 patients had lower back pain associated with lower limb pain;19 patients had lower back pain associated with numbness of lower limb;18 patients had lower back pain associated with lower limb muscle weakness and 2 pa？tients had urination and defecation function disturbance. The surgical operation time, bleeding, postoperative drainage flow, graft fusion rate, complications were measured, and the intervertebral disc height, Japanese Orthopaedic Association （JOA）, Oswestry disability indes （ODI）, visual analogue scale （VAS） score were compared before and after treatment. Results The operation of 34 patients was successfully completed with the average operation time of 1.8 ± 0.8 h, and the bleeding in operation was 362.4 ± 93.7 ml, while postoperative drainage flow was 116.3±54.2 ml. All patients were effectively followed up for 12 months to 46 months （av？erage, one year and 10 months）. Two weeks after operation, the intervertebral disc height were obviously increased （9.85±1.11 mm, 9.63 ± 1.04 mm）, and there were significant difference compared with preoperative results （6.53 ± 0.98 mm, 6.24 ± 1.07 mm）, but there were no significant difference compared with the latest follow？up results （9.23±1.33 mm, 9.30±1.16 mm）. At the latest follow？up, JOA score was 13.19±1.08, ODI score 12.34±7.52, VAS score 2.23±1.51, and

关 键 词：腰椎 脊椎前移 脊柱融合术 

分 类 号：R687.3[医药卫生—骨科学]