轴向融合联合经皮螺钉治疗轻中度腰5椎体滑脱症的临床观察  

Axial lumbar interbody fusion plus percutaneous pedicle screws for the treatment of mild to moderate lumbosacral spondylolisthesis

作　　者：欧阳智华[1] 阙伊辰 宋西正[1] 王程[1] 晏怡果[1] 王文军[1] 

机构地区：[1]南华大学附属第一医院脊柱外科,湖南衡阳421001

出　　处：《中南医学科学杂志》2017年第3期226-229,233,共5页Medical Science Journal of Central South China

基　　金：国家自然科学基金(81272055)

摘　　要：目的比较经皮骶前间隙轴向融合术联合经皮椎弓根螺钉术的"组合微创"技术和传统开放后路椎弓根螺钉内固定术治疗轻中度腰5椎体滑脱症的临床效果。方法无根性症状腰5椎体滑脱症患者39例(Meyerding分级均≤Ⅱ度),其中17例采用"组合微创"技术,22例采用"传统开放"技术,对两组病例围手术期指标、随访影像学指标、疼痛改善情况进行组内及组间比较。结果两组术后1周和末次随访的Meyerding分级、椎间隙高度、疼痛视觉模拟量表评分与术前比较均有统计学差异(P<0.05),末次随访与术后1周对比均无统计学差异;传统开放组术中出血平均值大于组合微创组(P<0.05),两组手术时间、住院天数对比无统计学差异。结论经皮骶前间隙轴向融合联合经皮椎弓根螺钉技术治疗Meyerding分级≤Ⅱ度且无根性症状的腰5/骶1滑脱症相对于传统腰椎后路开放手术具有出血少、创伤小等微创优势。这种"组合微创"技术是治疗腰5/骶1滑脱症可行且有效的方式。Objective To evaluate the clinical outcomes of axial lumbar interbody fusion（ Axia LIF） plus percutaneous pedicle screws and traditional posterior pedicle screws for mild to moderate lumbosacral spondylolisthesis. Methods Among 39 patients with waist 5 vertebral slippage disease of no root symptom,17 cases suffering from lumbosacral spondylolisthesis underwent Axia LIF plus percutaneous pedicle screws treatments and other 22 cases were treated with traditional posterior pedicle screws,which were reviewed retrospectively（ all the cases without root symptoms and Meyerding classification ≤Ⅱdegree）.Perioperative index,follow-up imaging indicators and pain assessments were analyzed within and between groups. Results There was significant difference at the time of 1 week postoperatively and final follow-up in both groups compared with preoperatively in Meyerding grade,intervertebral disc height and visual analogue scale score（ P〈0.05）.There was no statistical difference between 1 week postoperatively and final follow-up.The average intraoperative blood loss during Axia LIF plus percutaneous pedicle screws group was significantly lower than traditional posterior pedicle screws group（ P〈0. 05）.No statistical difference was found in average operative time and hospitalization days between the two groups. Conclusions Axia LIF plus percutaneous pedicle screws compared with the traditional posterior pedicle screws has statistical advantages in less bleeding,less trauma for lumbosacral spondylolisthesis（ without root symptoms and Meyerding classification ≤Ⅱdegree）.This surgical procedure is an alternative and promising method for mild to moderate spondylolisthesis treatment.

关 键 词：骶前间隙轴向融合 经皮椎弓根螺钉 腰椎滑脱 组合微创 

分 类 号：R681.5[医药卫生—骨科学]