PLIF技术在退变性腰椎滑脱并椎管狭窄症治疗中的应用  

Application of posterior lumbar interbody fusion in treatment of degenerative lumbar spondylolisthesis with spinal stenosis

作　　者：蔡平原[1] 黄帅[2] 陈升浩[1] 郑启新[2] 

机构地区：[1]湖北医药学院附属随州医院骨科,湖北随州441300 [2]华中科技大学同济医学院附属协和医院骨科,湖北武汉430022

出　　处：《生物骨科材料与临床研究》2016年第3期34-37,41,共5页Orthopaedic Biomechanics Materials and Clinical Study

摘　　要：目的分析研究使用单枚椎间融合器（Cage）的腰椎后路椎体间融合技术（PLIF）在退变性腰椎滑脱并椎管狭窄症中的应用效果。方法选择2010年10月-2014年1月期间的退变性腰椎滑脱并椎管狭窄症患者42例,其中男22例,女20例;年龄41-76岁,平均61.9岁。所有患者均采用全椎板减压、椎间盘摘除、椎弓根钉系统复位内固定、后路椎体间融合术,融合均采用单枚椎间融合器（Cage）加自体骨粒植入。术后随访1-3年,平均1.7年。临床症状采用JOA评分、VAS评分和ODI评分来评价,影像学表现评价指标包括滑脱率、椎间隙高度、腰椎前凸角和植骨融合率。结果临床症状,术后6个月JOA评分、VAS评分和ODI评分均较术前有明显改善,且均具有统计学意义（P〈P〈0.05）。影像学表现,滑脱率、椎间隙高度和腰椎前凸角在术后6个月均获得明显的恢复,术前与术后的差异具有统计学意义（P〈P〈0.05）。随访42例病例均达骨性愈合,融合率为100%。结论经全椎板减压、椎间盘摘除、椎弓根钉系统复位内固定、后路椎体间融合术,可以达到彻底椎管减压,有效改善患者脊髓神经功能及生活质量。采用单枚Cage的PLIF技术能有效恢复和维持脊柱生理稳定性,可获得满意的影像学表现,融合率高,并发症风险低。Objective To evaluate the therapeutic effects of posterior lumbar interbody fusion（PLIF） using an unilateral single cage for degenerative lumbar spondylolisthesis with spinal stenosis. Methods From 2010 Octto 2014, 42 patients suffering from degenerative lumbar spondylolisthesis with spinal stenosis, 22 males and 20 females, range 41 to 76 years,mean age of 61.9 years. Underwent entire vertebral plate decompression, intervertebral disc removal, internal fixation replacement by pediclescrew system, PLIFusing an unilateral single cage filled with local morselized bone graft for lumbar spondylolisthesis. All the 42 cases followed up for 1 to 3 years, with an average of 1.7 years. The Japaneses Orthopedic Association（JOA）, visual analog scale（VAS） and Oswestry Disability Index（ODI） was used for evaluating clinical outcomes. Radiographic outcomes included percentage of vertebral slippage, focal lordosis, disc height and fusion rate.Results For the clinical evaluation, the postoperative JOA, VAS, ODI scores were significantly improve than preoperative（ P〈0.05）, For the the radiological evaluation,percentage of vertebral slippage, focal lordosis, disc height were significantly improve than preoperative（ P〈0.05）. 42 cases showed complete bone union at the last follow-up, the fusion rate was100%. Conclusion Entire vertebral plate decompression, intervertebral disc removal, internal fixation replacement by pediclescrew system, PLIF for lumbar spondylolisthesis can provide complete decompression, the quality of life of the patients was obviously improved after operation. PLIF has higher rate of fusion,might effectively restore and maintain the stability of the spine, provide satisfactory radiographic outcomes, reduce the risk of complications.

关 键 词：腰椎滑脱 腰椎后路椎体间融合 单枚椎间融合器 

分 类 号：R687.3[医药卫生—骨科学]