后路双侧开窗减压PLIF内固定治疗退变性腰椎不稳症

Treatment of Lumbar Instability by Bilateral Fenestration PLIF Inner Fixation

目的探讨双侧开窗减压、黄韧带切除、后路腰椎椎体间植骨融合(Posterior Lumbar Interbody Fusion:PLIF)、内固定治疗退变性腰椎不稳症。方法89例临床患者、男41例、女48例;年龄45～75岁,平均63岁;病变部位L2-3间隙2例,L3-4间隙36例,L4-5间隙68例,L5-S1间隙5例,两节段椎间融合26例,三节段椎间融合10例,四节段椎间融合3例;伴椎体I滑脱28例,伴有大于15度侧凸的4例。术前常规摄腰椎正侧位、双斜位、腰椎过伸过屈动力位片、CT及MRI,了解椎管狭窄及椎体不稳程度;经腰椎后路行椎弓根钉棒系统内固定、开窗椎管减压、自体骨及CAGE(PEEK材料)椎间植骨融合手术治疗,术中行撑开提拉,将减压的自体椎板骨质修整,颗粒状碎骨填充于CAGE内,块状较大的骨块植入椎间隙,术后1周带腰围或佩戴支具下床活动。结果本组随访时间3个月至4年,术后拍片复查,随访X线片显示椎间植骨融合良好,椎体复位无丢失,螺钉无折断和松动。手术前、后椎体滑移距离和ODI指数两项参数的配对比较差异有显著性。结论椎弓根钉棒系统内固定、开窗椎管彻底减压、自体骨混合CAGE(PEEK材料)椎间植骨融合是治疗退变性腰椎不稳症的一种有效手术方法。

Objective To evaluate the effect of double side bilateral fenestration,excision of the ligamentum flavum,posterior lumbar interbody fusion and fixation on the treatment of degenerative lumbar instability.Methods A total of 89 patients involved in this study.There were 41 males and 48 females with anaverage age of 63 years（ranged,45~75 years） and the level of disc including L2-3 for 2 cases,L3-4 for 36 cases,L4-5 for 68 cases,L5-S1 for 5 cases,2 segments intervertebral body fusion for 26 cases,3 segments intervertebral body fusion for 10 cases,4 segments intervertebral body fusion for 3 cases,I degree lumbar spondylolisthesis for 28 cases,≥15 degree scoliosis for 4 cases.All patients were examined by X-ray with A-P position,oblique position dynamic lateral position,CT and MRI before operation.The vertebral canal narrowness and lumbar instability were observed.All patients were treated by vertebral pedicle screws-rods system fixation,bilateral fenestration,posterior lumbar interbody fusion.The slipped lumbars were distracted.The polyetheretherketone（PEEK） cage was filled with auto-radiu and impacted into the intervertebral body space.All the patients got out of bed 3 weeks after operation with the assistance of girdle brace.Results All the patients were followed up for 3～48 months after operation.Radiographs showed that the bone graft fusion of intervertebral body space was good.No postreduction disposition,internal fixation loosening or breakage occurred.There was significant difference between vertebral slip and ODI index in pre-and post-operative.Conclusion The operation with vertebral pedicle screws-rods system fixation,bilateral fenestration,posterior lumbar interbody fusion is a effective technique for degenerative lumbar instability.