单枚椎间融合器短节段椎弓根螺钉内固定治疗腰椎失稳症

Clinical outcome of single-cage combined with short-segment pedicle instrumentation for lumbar spine instability

目的:评价单枚椎间融合器植骨融合短节段椎弓根螺钉内固定治疗腰椎失稳症的临床疗效。方法:1999年3月～2007年8月我院采用单枚椎间融合器植骨融合结合短节段椎弓根螺钉内固定治疗腰椎失稳症患者中资料完整的病例149例,男83例,女66例,年龄32～68岁,平均46.7岁。失稳节段:L3/47例,L4/550例,L5/S192例。采用NaKai评定标准判定术后疗效,观察术后失稳椎体间有无移位,椎弓根螺钉及椎间融合器位置情况;测量术前、术后1周、术后16个月失稳椎间隙高度与上位椎间隙高度的比值。结果:手术时间1.5～3h,平均1.8h;术中出血量200～600ml,平均490ml。并发硬膜囊撕裂5例,神经根牵拉伤4例。随访16个月～6年9个月,平均39个月,术后腰椎序列恢复正常;术后1周失稳椎间隙高度与上位椎间隙高度的比值与术前比较有统计学差异(P<0.05),术后16个月与术后1周比较无统计学差异(P>0.05);术后16个月时按NaKai标准评定,优115例,良26例,可8例,优良率94.5%;术后16个月时,按Suk标准评定椎间融合率为100%;末次随访时无失稳复发,椎弓根螺钉及椎间融合器均无松动、移位等。结论:单枚椎间融合器植骨融合短节段椎弓根螺钉内固定是治疗腰椎失稳症比较可靠的方法,能很好地维持椎间隙的高度和节段的稳定。

Objective：To evaluate the clinical efficacy of single-cage combined with short-segment pedicle instrumentation for lumbar spine unstability.Method： 149 consecutive cases with lmnbar spine instability from March 1999 to August 2007 undergoing the above treatment were reviewed retrospectively.Among these eases, there were 83 males and 66 females,with the average age of 46.7 years-old （range,32-68 years old）,definite instability was determined at L3/4 in 7 cases,L4/5 in 50 cases and L5/S1 in 92 cases.NaKai criterion was used to determine postoperative clinical effect.All cases were followed up to notify the vertebral and instru- ment displacement.The ratio of the height of instability intervertebral space and their adjacent cranial space at 1 week and 16 months after operation were measured respectively.Result：The operating time was 1.5-3 hours （average,1.8 hours）,with blood loss approximately of 200-600ml （average,490ml）.4 cases were complicated neurological deficit and 5 cases had dural tear.The average follow-up time was 39 months （range, 16 months to 81 months ） .The lumbar spine alignment returned to normal after operation.There was significant difference with respect to intervertebral space height between preoperative and 1 week after operation （P〈0.05）,while no significant difference were noted between 1 week and 16 months after operation （P〉0.05）.Aecording to NaKai criterion,at 16th month after operation,ll5 cases were classified as excellent,good in 26 cases and fair in 8 cases with the excellent and good rate of 94.5%.According to Suk criterion,the fusion rate was 100% at 16th months after operation with no recurrence of instrument failure at final follow-up.Conclusion：Single-cage combined with short-segment pediele instrumentation for lumbar spine instability is a safe and reliable,which can maintain the intervertebral disc height and stabilization as well.