椎弓根螺钉内固定联合腰椎后路椎间融合治疗高龄退行性腰椎滑脱症  

Pedicle screw fixation combined with posterior lumbar interbody fusion for degenerative lumbar spondylolisthesis in the elderly

作　　者：陈康武[1] 张凯[1] 陈昊[1] 王根林[1] 朱晓宇[1] 钱忠来[1] 杨惠林[1] 

机构地区：[1]苏州大学附属第一医院骨科,江苏省苏州市215006

出　　处：《中国组织工程研究》2017年第23期3688-3693,共6页Chinese Journal of Tissue Engineering Research

基　　金：江苏省高校自然科学研究面上项目基金(16KJD320004);苏州市"科教兴卫"青年科技项目基金(kjxw2014009)资助~~

摘　　要：背景:目前关于滑脱椎体是否需要复位临床存在一定争议。目的:观察椎弓根螺钉内固定联合腰椎后路椎间融合(PLIF)治疗70岁以上高龄退行性腰椎滑脱症患者的手术疗效。方法:回顾性分析30例70岁以上高龄退行性腰椎滑脱症患者采用腰椎后路椎弓根内固定术、减压联合椎体间融合治疗的临床资料。对内固定前后的疼痛目测类比评分,Oswestry功能障碍指数(ODI)和日本骨科学会(JOA)腰椎评分进行比较分析。结果与结论:(1)30例患者男12例,女18例,平均年龄为(75.1±6.7)岁。所有患者均顺利完成手术,随访时间均在12个月以上;(2)内固定后目测类比评分为显著优于内固定前(P<0.05);内固定后ODI指数与腰椎JOA评分较内固定前有明显改善(P<0.05);腰椎JOA评分改善率情况:治愈3例,显著有效24例,有效3例,无效0例;(3)根据椎间融合判定标准,所有患者均达到骨性融合,平均融合时间为(5.13±0.65)个月(4-8个月);(4)平均手术时间(225.6±23.4)min,平均术中出血量(470±45.5)mL。平均随访时间为(25.8±3.5)个月;(5)手术相关并发症共有6例(20%),其中1例硬膜囊撕裂,2例麻痹性肠梗阻,3例一过性下肢神经症状加重;(6)结果说明,在积极控制全身伴发疾病的基础上,椎弓根螺钉内固定联合椎体间融合治疗高龄退行性腰椎滑脱可取得良好的手术效果。BACKGROUND： Whether lumbar spondylolisthesis needs to be treated with reduction remains controversial. OBJECTIVE： To investigate the clinical effectiveness of pedicle screw fixation combined with posterior lumbar interbody fusion for degenerative lumbar spondylolisthesis in the patients aged more than 70 years old. METHODS： The clinical data of 30 patients with degenerative spondylolisthesis aged over 70 years old undergoing pedicle screw fixation combined with posterior lumbar interbody fusion were analyzed retrospectively. The Visual Analogue Scale, Oswestry Dysfunction Index and the Japan Orthopedics Association scores were compared and analyzed before and after surgery. RESULTS AND CONCLUSION： （1） Among 30 patients, 12 were male and 18 female, the average age was （75.1±6.7） years old, and all were followed up for more than 12 months. （2） The postoperative Visual Analogue Scale, Oswestry Dysfunction Index and the Japan Orthopedics Association scores were significantly improved compared with baseline （P 〈 0.05）. According to the Japan Orthopedics Association scores, 3 cases were cured, 24 were significantly effective, and 3 effective. （3） Graft fusion was achieved at all patients, the average fusion time was （5.13±0.65） months. （4） The average operation time was （225.6±23.4） minutes, the average intraoperative blood loss was （470±45.5） mL, and the average follow-up time was （25.8±3.5） months. （5） Six patients presented complications （20%）, including one case of dural tear, two cases of paralytic intestinal obstruction, and three transient lower extremity nerve symptoms. （6） These results indicate that if the associated disorders are strictly controlled, pedicle screw fixation combined with posterior lumbar interbody fusion can achieve good surgical results in the treatment of degenerative spondylolisthesis in the elderly.

关 键 词：骨科植入物 脊柱植入物 腰椎 退行性 滑税 高龄 椎闻融合 

分 类 号：R318[医药卫生—生物医学工程]