经椎间孔椎间融合椎弓根螺钉内固定治疗腰椎不稳

Transforaminal interbody fusion and pedicle screw fixation for the treatment of lumbar spine instability

目的探讨经椎间孔椎间融合椎弓根螺钉内固定治疗在腰椎不稳的疗效和影响因素。方法经后外侧小切口单侧椎弓根固定加经椎间孔椎间融合治疗73例腰椎不稳患者。采用JOA评分、观测影像学改变及植骨融合率评价疗效,并对影响疗效的相关因素进行分析。结果 73例均获得随访,时间16～38个月。JOA评分:术前为(10.24±3.68)分,术后3个月为(20.18±3.89)分、术后2年为(20.83±4.01)分,与术前比较差异均有统计学意义(P<0.05)。其中优29例,良22例,中17例,差5例,优良率为69.9%。椎间隙高度:术前为(5.83±1.71)mm,术后3个月为(9.45±1.36)mm、术后2年为(8.96±1.28)mm,与术前比较差异均有统计学意义(P<0.05)。患者术后3个月、2年的节段活动度、矢状滑移距离均低于术前,差异均有统计学意义(P<0.05)。植骨融合率为87%。结论单侧椎弓根固定加经椎间孔椎间融合术能够恢复脊柱的稳定性,重建腰椎生理前凸,并能改善腰椎生物力学环境及恢复椎间隙高度。年龄<60岁、病程<24个月的患者手术治疗效果较好。

Objective To study the effect of transforaminal interbody fusion and pedicle screw fixation for the treatment of lumbar spine instability. Methods 73 lumbar instability cases were treated with posterolateral incision unilateral pedicle screw fixation and percutaneous transforaminal lumbar interbody fusion. JOA score,imaging changes, implantation fusion rate and related factors of influencing efficacy were recorded, and the results were statistically com- pared. Results All patients were followed up for 16 -38 months. JOA scores were （10.24 ±3.68）, （20. 18 ± 3.89）, and （20. 83 ± 4. 01 ） in preoperation, 3 months, and 2 years after surgery （P 〈 0. 05 ）. Patients JOA scores were 29 cases excellent,22 good,17 fair and 5 poor. The excellent and good rate was 69.9%. Intervertebral space height was （5.83 ± 1.71 ） ram, （9.45 ± 1.36 ）mm and （ 8.96 ± 1.28 ）mm in preoperation, 3 months, and 2 years after surgery（P 〈 0. 05 ）. Segmental mobility, sagittal slip distance in 3 months, and 2 years after surgery were lower than preoperation （P 〈 0. 05）. The implantation fusion rate was 87%. Conclusions Through small lateral incision after unilateral pedicle screw fixation combined with percutaneous transforaminal interbody fusion can restore stability of the spinal column, reconstruction of lumbar lordosis, and can improve lumbar biomechanical environment and restore the height of intervertebral space. When patients age is 〈 60 years and the disease course is 〈 24 months, the operation therapeutic effect is better.