退变性腰椎不稳症手术治疗的疗效分析

Treatment Outcomes of Operation for Lumbar Instable Disorders

目的:探讨退变性腰椎不稳症手术治疗的疗效。方法:随访我院60例腰椎不稳症患者运用椎板扩大开窗或全椎板切除减压,摘除髓核,椎体间植骨,后路钉棒系统加压内固定及腰椎间融合术。结果:术后随访半年到3.5年,平均12个月,复查X线示骨性融合,2例出现断钉及松动现象,患者症状完全消失48例,基本消失7例,无明显缓解5例(可3例,差2例)。根据日本骨科学会(JOA)评分法,优良率91.3%。结论:椎弓根螺钉内固定加椎管减压,椎体间植骨融合可使不稳节段即刻稳定,骨性融合率高,是治疗腰椎不稳症的较好方法。

Objective： To evaluate the clinical effectiveness of surgical treatment for lumbar instable disorders. Methods： From January 2005 to January 2008, 60 patients with lumbar instable disorders were treated with extended hemilaminotomy or total laminectomy decompression, disc excision, lumbar intervertebral fusion, and transpedicular instrumentation. Results： All 60 patients were followed up between 6 and 42 months （average 12 months）. The X-ray films of all patients showed good intervertebral fusion. Instrument breakage or looseness was found in two patients. Lower back pain completely disappeared in 48 patients and basically disappeared in seven patients, and mild back pain only occurred in 5 patients. Acording to the standard of JOA, excellent and effective rate of treatment was 91.3%. Conclusion： The way of transpedicle screw fixa tion, spinal canal decompression, and lumbar interbody fusion provides instant stability for unstable vertebral segments and the bone graft fusion rate is satisfactory, and it is an ideal method in treatment of lumbar instable disorders.