Vista系统联合Sextant-R系统微创治疗单间隙腰椎退行性滑脱症  

Vista system combined with Sextant-R system for minimally invasive treatment of single-gap degenerative lumbar spondylolisthesis

作　　者：徐峰 李涛 徐彬 谭林英 王智祥 XU Feng;LI Tao;XU Bin;TAN Linying;WANG Zhixiang(Department of Orthopaedics, Wuhan Hospital of Traditional Chinese Medicine, Wuhan 430070, China)

机构地区：[1]解放军武汉总医院骨科,武汉430070

出　　处：《骨科》2017年第6期428-432,450,共6页ORTHOPAEDICS

基　　金：湖北省自然科学基金(2014CFB473)

摘　　要：目的探讨Vista系统联合Sextant-R系统微创治疗单间隙腰椎退行性滑脱的临床疗效。方法回顾性分析2015年7月至2016年5月间接受Vista系统联合Sextant-R系统微创治疗的单间隙腰椎退变型疾病25例的临床资料。其中,男10例,女15例;年龄为48~79岁,平均(61.0±5.5)岁。L4/5滑脱12例,L5/S1滑脱13例。根据Meyerding分级:Ⅰ度滑脱23例,Ⅱ度滑脱2例。采用疼痛视觉模拟量表(visual analogue scale,VAS)及日本骨科协会(Japanese Orthopaedic Association,JOA)腰椎功能评分对病人术前、术后3 d(出院时)、末次随访的腰椎功能进行评估,并计算JOA改善率,采用Suk标准评价植骨融合率。结果 25例病人均获得随访,随访时间为6~13个月,平均(9.5±2.5)个月。术前VAS评分为(7.13±0.73)分,术后3 d为(1.58±0.51)分,末次随访为(1.21±0.31)分;术前JOA评分为(9.55±0.71)分,出院3 d为(19.32±2.21)分,末次随访为(27.57±2.38)分,术后3 d、末次随访时的VAS、JOA评分与术前比较,差异均有统计学意义(均P<0.05)。1例病人由于伴有骨化,骨化组织与硬脊膜粘连,出现脑脊液漏,术后经过持续引流、伤口加压等处理。所有病人伤口均一期愈合,均无神经根或脊髓损伤情况。滑脱均得到一定程度复位,植骨均骨性融合,内固定位置良好。结论 Vista系统联合Sextant-R系统微创治疗单间隙腰椎退变型滑脱临床效果确切,切实可行。Objective To evaluate the clinical efficacy of the minimally invasive treatment with Vista system combined with Sextant-R system for single?level degenerative lumbar spondylolisthesis.Methods This study retrospectively reviewed25consecutive patients with single-level lumbar degenerative disease between July2015and May2016,who were managed with surgery.Patients included10men and15women,aged61.0±5.5years(range48-79years).L4/5spondylolisthesis occurred in12patients,while L5/S1spondylolisthesis occurred in13patients.According to Meyerding radiographic grading system,23patients were of typeⅠand2of typeⅡ.Preoperation,three days postoperation(at discharge)and at last follow-up,lumbar functionscores on a visual analog scale(VAS)and Japanese Orthopaedic Association(JOA)were collected and the rate of JOA improvement was also calculated.The bony fusion rate was evaluated by the Suk standard.Results The duration of follow-up with25patients was6-13months(mean9.5±2.5months).The VAS score was7.13±0.73before operation,1.58±0.51at3rd day postoperation and1.21±0.31the VAS score at the last follow?up.Preoperative JOA score was9.55±0.71.The JOA score was19.32±2.21at3rd day after operation and27.57±2.38at the final follow-up was.There was statistically significant difference(P<0.05)in VAS and JOA scores between3rd day after operation and at the last follow-up with those preoperation.Cerebrospinal fluid leakage occurred in one case due to the ossification and adhesion of ossification tissue with epidural.The patient was cured by continuous drainage,direct pressure and other wound treatment after surgery.Wounds of all patients had primary healing and nerve roots or spinal cords were not injured.The reduction was achieved to some extent.All patients had good bone graft fusion and internal fixation was in good position.Conclusion The minimally invasive treatment with Vista system combined with Sextant-R system for single?level degenerative lumbar spondylolisthesis improves clinical outcomes.

关 键 词：VISTA系统 Sextant.R系统 外科手术 微创性 外科手术 计算机辅助 腰椎 

分 类 号：R687.3[医药卫生—骨科学]