后路椎体间植骨融合术治疗下腰椎不稳

Posterior Lumbar Interbody Fusion(PLIF) in Lumbar Instability

目的 :探讨后路椎体间植骨融合术治疗下腰椎不稳的手术技术并评价其应用价值。方法 :对明确诊断为下腰椎不稳的 32例患者进行后正中入路下的椎管狭窄减压手术 ,椎弓根螺钉植入并行椎间隙撑开 ,双侧切除椎间盘保留侧方以及前方的纤维环 ,刮除终板的软骨层 ,植入足量的松质骨以及椎板切除物 ,最后植入双条三面皮质骨的髂骨块 ,椎弓根螺钉系统加压固定。结果 :平均手术时间 ,平均失血量较常规手术无显著差别。 2 8例获得手术后的 3个月随访 ,原有的神经压迫症状大部恢复 ,行走距离增加最为明显。椎间高度术前 2 .8～ 6 .7mm ,平均高度 4 .2mm ,术后椎间高度 1 1 .8～ 1 4 .3mm ,平均 1 2 .6mm。在 3个月随访时平均高度为 1 0 .8～ 1 3 .2mm ,平均 1 1 .6mm。椎间孔 3个月后较术前增加6mm。 2 7例显示椎间隙的活动度小于 2°,椎体与植骨块交界处无透亮区。 1例植骨块吸收 ,但症状改善。最常见的并发症为脑脊液漏和神经根牵拉刺激 ,最终缓解。结论 :后路椎体间植骨融合术结合椎弓螺钉系统固定治疗下腰椎不稳满足充分减压 ,即刻的腰椎稳定性的重建以及长期可靠骨性融合治疗的基本要素。

Objective:To investigate posterior lumbar in te rbody fusion(PLIF) technique and its clinical value.Methods:Among 32 cases with lumbar instability,decompression for stenosis were performed firstly,pedicle scr ews were conducted and separated to increase the interbody space,disc was remove d while the anterior and lateral wall of fibrosus annulus were well preserved,th e cartilage layer of end plate were gentlly curetted,enough cancellous bone har v ested from iliac crest and laminectomy were inserted into the space. Finally,two tricortical bone grafts were conducted parallely with pedicle screw system com pre ss and locking.Results:With this procedure,averaging operation time and averagi n g blood loss are no different with that of common procedure.Twenty-eight cases were followe d-up for 3 months.Neuro deficit were recovered in most cases,walk distance incr eased obviously.Averaging interbody height was 4.2mm(2.8～6.7)preoperation,an d 12.6mm(11.8～14.3) just postoperation and 11.6mm(10.8～13.2)3 months after oper ation.The height of forman enlarged with 6mm.With dynamic rentography the ra nge of motion were less than 2°,there were no transparent region at the inter face between the vertebral body and bone graft.Bone graft absorbed in 1 case,but the symptoms were diminished.The common complications were the leakage of CSF and the tension irritation of the nerve root which could be relieved at last.Conclusion s:PLIF techni que feed the need of complete decompress,instant stability and sound bony fusion in the treatment of lumbar instability.