退行性腰椎不稳的临床影像解剖特征及治疗

The anatorric characteristics of clinical radiology of degenerative lumbar spine instability and its surgical treatment

目的:探讨退行性腰椎不稳症的临床影像解剖特征及手术治疗的疗效。方法:42冽病人,其中腰椎不稳合并腰椎管狭窄20例,退行性滑脱18例,退行性侧弯4例。全部病例均常规行X线正侧位片、左右斜位片以及腰椎动力性侧位片检查,观察脊柱不稳部位及节段;同时行CT或MRI检查,了解柞管及神经根管情况;依据病人的病情、年龄等情况采取相应的手术方案,术后佩戴外固定支柱并进行随访。结果:全部病例随访中X线片显示,除1例因严重骨质疏松造成螺钉松动外,椎弓根断裂1例,其余固定牢固,螺钉、棒无折断,复位无丢失,无感染及脊髓神经根损伤等并发症,植骨融合良好,优良率达93％。结论:L4/5屈时移位>8％、过伸时移位>9％;L5/S1过屈时移位>6％、过伸时移位>9％;或椎体前后移位>4mm,椎体问成角>10°为退行性下腰椎不稳的影像学特征。神经减压和椎管成型辅以后路椎弓根钉捧系统同定及植骨融合术治疗退行性下腰椎不稳疗效优良。

Objective: To investigate the radiological characteristics of degenerative lumbar spine instability and its therapeutic effect. Methods: 42 patients with degenerative lumbar spine (including 20 cases of degenerative lumbar spine instability complicated with vertebral canal stenosis, 18 cases with degenerative spondylolishesis and 4 cases with degenerative scoliosis) were examined by X-ray with A-P position, oblique position and dynamic lateral position. The location and segment of instability were observed. The vertebral canal and nerve root canal were evaluated on computed tomography or magnetic resonance imaging. According to their conditions and ages, the patients were carried out surgical treatments and followed-up after the operation. Results: Except broken pedicle of vertebral arch in one case and screw loosen in another one as a result of severe osteoporosis, of all the cases, the others' fixations were firm and the screws and rods were intact. No infection and nerve root injuries were found. Bone graft fusion was excellent. The fineness rate of therapeutic effect was 93%. Conclusions: The displacement in L4/5 is more than 8% in extra-flexion position and 9% in extra-extension position, and that in L5/S1 is more than 6% in extra-flexion position and 9% in extra-extension position. Besides, the anterior-posterior dimension is more than 4mm and the angulation of infra-vertebral body is more than 10o. The above mentioned are the radiological characteristics of degenerative lumbar instability. The therapeutic effect of nerve decompression and vertebral canal plasty combined with the screw-rod system fixation of posterior pedicle of vertebral arch and the fusion of bone graft is fine.