短节段固定联合椎板成形术治疗不稳定性L3退变性Ⅰ度滑脱伴下腰椎管狭窄症  

Short segment fixation combined with fenestration in treatment of degenerative instability in L_3 degreeⅠspondylolisthesis with lumbar spinal stenosis

作　　者：李一鹏[1] 田玉良[1] 段晓丰[2] 于海泉[1] 曹斌[1] 王猛[1] 

机构地区：[1]河北省石家庄市第一医院骨三科,河北石家庄050011 [2]河北医科大学第二医院麻醉科,河北石家庄050000

出　　处：《河北医科大学学报》2016年第6期676-679,共4页Journal of Hebei Medical University

基　　金：河北省医学科学研究重点课题(ZL20140288)

摘　　要：目的观察短节段固定联合椎板成形术治疗不稳定性L3退变性Ⅰ度滑脱伴下腰椎管狭窄症的临床疗效。方法对39例不稳定性L3退变性Ⅰ度滑脱伴下腰椎管狭窄的患者进行L3~4短节段固定及下腰段椎板成形术治疗,观测手术出血量、手术时间、并发症发生情况,并采用日本骨科协会（Japanese Orthopedic Association,JOA）评分对手术疗效进行评估。通过影像学定期观察术后内固定位置、植骨融合情况以及病变节段滑脱情况。结果观测指标如下：手术失血量（400.0±80.6）mL,手术时间（133.0±28.4）min,术中硬脊膜撕裂并发症2例;本组患者术后症状缓解明显,JOA评分较术前明显改善;术后定期随访钉棒系统位置满意,椎间融合器无下沉及移位,滑脱无加重;除1例出现假关节外,6个月复查时均融合。结论 L3~4短节段融合固定联合下腰段有限单纯减压治疗不稳定性L3退变性Ⅰ度滑脱,手术创伤更小,保留了部分脊柱活动度,减轻了患者经济负担,疗效满意。Objective To explore the clinical effect of short segment fixation combined with fenestration in the treatment of degenerative instability L3 degree Ⅰ spondylolisthesis with lumbar spinal stenosis disease.Methods Thirty-nine patients who suffered from degenerative instability L3 degree Ⅰ spondylolisthesis with lumbar spinal stenosis were treated with short segment fixation combined with fenestration.Operative bleeding volume、operation time、complication occurrence were observed.Japanese Orthopedic Association（JOA）score was adopted to evaluate postoperative effec.Periodic observation with radiographic imaging,postoperative internal fixation、fusion of bone and slippage of the segment after surgery were examined.Results Observed indicators were as follows：operative bleeding volume was（400.0±80.6）mL,operation time was（133.0±28.4）min,complication occurrence was 2/29.The symptoms were relieved obviously in the group of patients after the operation.with higher JOA scores.The position of nail stick system was good,without cage subsidence,displacement and increasement in slip.Six months after operation,lumbar fusion between L3 and L4 was good except one case.Conclusion Short segment fixation combined with Posterior limited spinal decompression in the treatment of degenerative instability L3 degree Ⅰ spondylolisthesis with lumbar spinal stenosis has advantages of minimal invasion,retains part of the spinal mobility,alleviates the economic burden of the patient,and shows good effects.

关 键 词：椎管狭窄 关节融合术 脊椎滑脱 

分 类 号：R681.5[医药卫生—骨科学]