摘要
目的观察局部自体骨移植治疗峡部裂性腰椎滑脱症(Adult isthmic spondylolisthesis,AIS)的临床疗效。方法41例无明显骨质疏松的AIS患者,采用术中切除的滑脱椎棘突、椎板、关节突行椎间支撑植骨融合及非万向椎弓根螺钉系统固定,随访观察该组患者临床疗效。结果41例患者均采用四钉二棒的非万向螺钉系统行单节段融合(L3,42例,L4,523例,L5S116例);合并滑脱椎相邻节段椎间盘突出、椎间不稳定及椎管狭窄需行开窗减压神经根探查者均不予固定融合7例;手术时间2.5~3.5小时,出血量200~800ml,平均出血量320ml;术中置钉时发生钉道破裂3次,发生硬膜囊破裂3例,神经根袖破裂2例;33例随访3月至4年,平均2.3年,腰背痛明显减轻28例,腿痛减轻或消失16例,残余肢体麻木3例,足背伸肌力Ⅲ~Ⅳ级2例,腰椎疾患日本骨科学会(JOA)评分由术前(13.3±4.0)分恢复到末次随访时(26.6±3.3)分;X射线片示椎间植骨融合良好29例;滑脱复位有部分丢失3例,植骨块脱出于椎体后缘1例,钉棒系统断裂1例。结论局部自体骨移植结合非万向椎弓根螺钉系统牢固固定,取材和植入方便,来源丰富,是AIS患者椎间融合方法之一。
Objective To observate clinical effects using local self-lamina autograft in adult isthmic spondylolisthesis(AIS). Methods 41 patients who had AIS without obvious osteoporosis were operated by local self-lamina autograft (inclued spinions,lamina and facet) harvested from slipping vertebrae and no-multioriention pedicel screw devices. Clinical results were followed up. Results A total of 41 patients were operated smoothly. Operation time was 2.5~3.5 hours and the arerage was 3 hours,and estimated blood loss were 200~800 ml,average 320 ml. 3 pedicle fracture taken place intraoperation 5 cases had CSF leak,33 patient were followed from 3 months to 4 years and average 2.3 years. Relief of lower back pain were observed in 28 cases,16 cases had relief of the lower leg and buttocks pain,calf numbness existed in 3 cases and dorsal foot hypesthesia were in 2 cases. The mean neurological score according to JOA improved from 13.4±4.0 before operation to 26.6±3.3 at last follow,good intervertebrae fusion had happened in 29 cases pyuedarthrosis was suspected in 2 cases. Partly loss of slipping vertebral reduction were in 2 cases,graft mass shifted to the posterior edge of the intervertesrial space in 1 case,screw-rod instrumention had loosened and broken in 2 case. Conculsion One of the good fusion way in PLIF for AIS is local autograft and rigid pedicle screw fixation because of convenience of harvesting and inserting fusion material.
出处
《实用医院临床杂志》
2010年第1期29-32,共4页
Practical Journal of Clinical Medicine
关键词
脊柱滑脱
腰椎
融合
自体骨移植
固定
Isthmic spondylolisthesis
Lumbar
Fusion
Autograft
Fixation