老年中重度腰椎滑脱的影像学特点及手术治疗体会

Imaging features and surgical treatment of mid-to-severe lumbar spondylolisthesis in the elderly

目的分析老年中、重度腰椎滑脱病人的影像学特点,观察行"后路环形松解减压+万向椎弓根钉复位+Cage椎间融合"手术后的效果。方法收集2015年6月至2019年4月中国科学技术大学附属第一医院收治的30例年龄≥60岁、Ⅱ度及以上腰椎滑脱病人的影像资料,分析其影像学特点;并对术后疗效进行随访评价。术前影像学资料示滑脱节段峡部裂型22例,退变型8例,滑移率为45.00%±10.20%,椎间高度为(3.97±2.70)mm,椎间倾斜角为1.07°±8.07°,其中10例呈负值,滑脱节段的终板改变26例,动态不稳7例;骨质疏松24例,其中伴椎体骨折8例;邻近节段椎间改变11例。结果术后影像学显示滑移率降为7.00%±5.30%,矫正率为89.00%±6.00%,椎间高度恢复至(11.50±1.25)mm,椎间倾斜角度纠正到7.20°±5.10°,与术前比较,差异均有统计学意义(P<0.05)。Nakai评分优良率为96.67%(29/30)。28例获得1年以上随访,椎间骨性愈合,未有再次滑脱等情况。结论老年中、重度腰椎滑脱多伴骨质疏松、较多的椎间及邻近节段改变,但稳定性较强。经后路环形松解减压,有利于复位,避免了强行复位导致内固定松动。Cage椎间融合提高即刻稳定性及术后愈合率,可有效治疗老年中、重度腰椎滑脱。

Objective The imaging characteristics of elderly patients with moderate and severe lumbar spondylolisthesis were analyzed, and the surgical effect of"posterior annular decompression to loosen+universal pedicle nail reduction+cage intervertebral fusion"was observed. Methods The imaging data of 30 cases of lumbar spondylolisthesis(≥Ⅱ degree) aged over 60 years and treated in First Affiliated Hospital of China University of Science and Technology from June 2015 to April 2019 were collected and organized. The imaging characteristics were analyzed, then the postoperative curative effect was evaluated and followed up.Under the intervertebral condition of the vertebral slip, there were 22 cases of spondylolysis and 8 cases of degeneration. Slip rate was 45.00%± 10.20%, average intervertebral height was(3.97 ± 2.70) mm, the intervertebral inclination angle was 1.07°±8.07°, and negative in 10 cases. There were 26 cases of endplate changes in slippage disjunction, and dynamic instability in 7 cases. There were 24 cases of osteoporosis,including 8 cases of vertebral fracture;11 cases of adjacent segment intervertebral changes. Results For postoperative imaging changes, slip rate decreased to 7.00%±5.30%, and correction rate was 89.00%±6.00%.The intervertebral height was restored to(11.50±1.25) mm. The intervertebral tilt angle was corrected by 7.20°±5.10°. There were significant differences before and after surgery. For clinical efficacy evaluation, the excellent and good rate of Nakai score was 96.67%(29/30). All the 28 cases were followed up for more than 1 year. The intervertebral bones healed and no slippage occurred again. Conclusion Middle and severe lumbar spondylolysis in the elderly was mainly isthmus fracture, with more osteoporosis, more intervertebral and proximal segment changes, but with stronger stability. Decompression of the posterior ring is conducive to the reduction of the sliding vertebral body and avoids the internal fixation and loosening caused by forced reduction. Cage intervertebral fusion improves immediate stability and postoperative intervertebral healing rate.The method can effectively treat the elderly moderate and severe lumbar spondylolisthesis.