姚弘毅,刘平,杨盛力,韦卓,柳湘洁
YAO Hongyi,LIU Ping,YANG Shengli,WEI Zuo,LIU Xiangjie

• 1:华中科技大学同济医学院附属梨园医院康复医学科
• 2:华中科技大学同济医学院附属梨园医院骨科
• 3:香港中文大学外科系

摘要(Abstract)：

目的:探讨后路钉棒系统联合Cage植骨融合治疗峡部裂型腰椎滑脱的临床疗效。方法:选择峡部裂型腰椎滑脱症患者37例,采用后路椎板切除,钉棒系统联合Cage植骨融合治疗,观察术后愈合情况,复查X片;比较手术前以及手术后最后1次随访时,患者腰椎JOA功能评分;平均随访38个月,并进行JOA功能评分。结果:术后伤口Ⅰ期愈合35例,1名患者出现伤口脂肪液化,1例出现脑脊液外露;X线片复查示植骨于13~42周出现骨性融合,1例Cage融合器沉陷1 mm,36例患者未出现钉棒松动、断裂、移位,椎间隙高度和滑脱椎体复位无丢失;手术后JOA评分高于手术前,差异有统计学意义(t=10.34,P<0.05);所有患者随访过程中功能改善满意,治疗后改善率为86.5%。结论:后路钉棒系统联合Cage植骨融合治疗腰椎滑脱症,能有效的解除病变部位对患者脊髓、神经根的压迫,改善腰椎功能,疗效确切。
Objective: To evaluate the clinical efficacy of posterior pedicle screw joint combined with Cage fusion for treatment of isthmic spondylolisthesis. Methods: Tirty-seven cases of patients with lumbar spondylolisthesis were enrolled in this study,whowere treated by posterior laminectomy and pedicle screw joint combined with Cage fusion. Then postoperative healing was observed and X-ray film was reexamined. Lumbar JOA function scores in the last follow-up visit before and after surgery were compared. After average 38 months follow-up visits,Lumbar JOA function scores were compared again. Result: After surgery,there were 35 cases of wound healingⅠ,with one patient of wound fat liquefaction and one patient of cerebrospinal fluid exposure. X ray re-examination showed that bone to bone fusion occurred in 13 ~ 42 weeks,with one case of fusion Cage subsidence by 1mm. In the other36 cases,there appeared no pedicle screw loosening,fracture,displacement,and there was no loss of vertebral disc space height and slipped vertebral reset. Lumbar JOA function score after surgery was significantly higher than before surgery( t = 10. 34,P < 0. 05). The function improvement of all patients in follow-up visit was satisfying,and after treatment the improvement rate was 86. 5%. Conclusion: The posterior pedicle screw joint combined with Cage fusion for treatment of isthmic spondylolisthesis can relieve pressure on spinal cord and nerve root inflicted by diseased region,improve lumbar function with assured efficacy.

关键词(KeyWords)： 腰椎;脊椎滑脱;钉棒系统;Cage;植骨融合;疗效观察
lumbar;spondylolysis vertebrae;nail-rod system;cage;bone-implantation;clinical observation

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 姚弘毅,刘平,杨盛力,韦卓,柳湘洁
YAO Hongyi,LIU Ping,YANG Shengli,WEI Zuo,LIU Xiangjie

DOI: 10.19367/j.cnki.1000-2707.2015.10.035

参考文献(References)：

• [1]Harroud A,Labelle H,Joncas J,et al.Global sagittal alignment and health-related qual ity of l ife in lumbosacral spondylol isthesis[J].Eur Spine J,2012.[Epub ahead of print].
• [2]曹延林,朱立新,闵少雄,等.重度腰椎滑脱手术治疗体会[J].中国矫形外科志,2012(9):608-609.
• [3]Audat Z,Moutasem O,Yousef K,et al.Comparison of clinical and radiological results of posterolateral fusion,posterior lumbar interbody fusion and transforaminal lumbar interbody fusion techniques in the treatment of degenerative lumbar spine[J].Singapore Med J,2012(3):183-187.
• [4]Niemeyer TK,Koriller M,Claes L,et al.In vitro study of biomechanical behavior of anterior and transforaminal lumbar interbody instrumentation techniques[J].Neurosurgery,2006(6):1271-1276.
• [5]冯大倡,周志遥,黎健鹏.不同原因的腰椎滑脱症手术治疗效果分析[J].中国骨与关节损伤杂志,2013(5):456-457.
• [6]杨磊落,李青.胸腰段骨折前外侧入路术后脑脊液漏的原因及治疗[J].贵阳医学院学报,2013(1):79-83.
• [7]Musluman AM,Yilmaz A,Cansever T,et al.Posterior lumbar interbody fusion versus posterolateral fusion with instrumentation in the treatment of low-grade isthmic spondylolisthesis:midterm clinical outcomes[J].J Neurosurg Spine,2011(4):488-496.
• [8]康健,徐皓,陈建梅,等.椎弓根钉棒系统联合双椎间融合器植骨治疗腰椎滑脱症[J].临床军医杂志,2012(3):632-634.

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