CAJ | 학술논문

背景:对椎弓峡部裂腰椎滑脱、退行性腰椎滑脱的治疗,到底是采用短节段固定还是长节段固定争论很多.目的:观察短节段或长节段椎弓根钉内固定治疗腰椎滑脱的临床疗效.方法:腰椎滑脱患者146例,男36例,女110例,年龄22~73岁,平均53岁,病程1~18年,平均5年.采用腰椎管扩大开窗减压或全椎板切除减压、短节段或长节段椎弓根螺钉复位内固定、横突间或椎体间植骨融合.结果与结论:146例患者中采用短节段4枚椎弓根螺钉固定72例,长节段6枚椎弓根螺钉固定74例.椎间植骨101例,横突间植骨45例.术后随访134例,随访时间1.5~14年,按Steffee临床疗效分级标准,优74例,良41例,中13例,差6例,优良率85.8%.完全复位77例,其中短节段固定32例,长节段固定45例;部分复位69例,其中短节段固定40例,长节段固定29例.短节段固定者有8例13枚椎弓根螺钉发生断裂,而长节段固定者未发生椎弓根螺钉断裂.分析患者腰椎滑脱的类型、程度、病程长短、是否合并相邻节段椎间盘退变、不稳等情况,是选择用短节段还是用长节段置入固定的依据.
배경:대추궁협부렬요추활탈、퇴행성요추활탈적치료,도저시채용단절단고정환시장절단고정쟁론흔다.목적:관찰단절단혹장절단추궁근정내고정치료요추활탈적림상료효.방법:요추활탈환자146례,남36례,녀110례,년령22~73세,평균53세,병정1~18년,평균5년.채용요추관확대개창감압혹전추판절제감압、단절단혹장절단추궁근라정복위내고정、횡돌간혹추체간식골융합.결과여결론:146례환자중채용단절단4매추궁근라정고정72례,장절단6매추궁근라정고정74례.추간식골101례,횡돌간식골45례.술후수방134례,수방시간1.5~14년,안Steffee림상료효분급표준,우74례,량41례,중13례,차6례,우량솔85.8%.완전복위77례,기중단절단고정32례,장절단고정45례;부분복위69례,기중단절단고정40례,장절단고정29례.단절단고정자유8례13매추궁근라정발생단렬,이장절단고정자미발생추궁근라정단렬.분석환자요추활탈적류형、정도、병정장단、시부합병상린절단추간반퇴변、불은등정황,시선택용단절단환시용장절단치입고정적의거.
BACKGROUND: There are a lot of controversies regarding the choice of short versus long segment pedicle screw fixation for the treatment of isthmic spondylolisthesis and degenerative spondylolisthesis treatment. OBJECTIVE: To investigate clinical efficacy of short versus long segment pedicle screw fixation in treatment of lumbar spondylolisthesis.METHODS: A total of 146 spondylolisthesis patients were included in this study, 36 males and 110 females, aged 22-73 years at a mean of 53 years; disease duration was from 1 to 18 years at a mean of 5 years. These patients were treated with lumbar spinal window-opened decompression or laminectomy decompression, a short or long segment pedicle screw internal fixation, transverse interbody fusion.RESULTS AND CONCLUSION: Among 146 involved patients, 72 cases were treated with four pedicle screw fixation (short segments), while 74 cases with six pedicle screw fixation (long segments). Interbody graft was performed in 101 cases, while intertransverse fusion given in 45 cases. Totally 134 cases were followed up for postoperative 1.5-14 years. According to clinical grading standards of Steffee system, the clinical efficacy was assayed excellent in 74 cases, good in 41 cases, mild in 13 cases and poor in 6 cases, with good rate of 85.8%. 77 cases achieved a complete reduction, including 32 cases using a short segment fixation and 45 cases using a long segment fixation. 69 cases achieved partial reduction, including 40 cases using a short segment fixation and 29 cases using a long segment fixation. Pedicle screws ruptures were found in 13 screws of eight patients undergoing short segment fixation, while no pedicle screw fracture was found in long segment fixation. Choice of short or long segment for the fixation is based on the analysis of spondylolisthesis type, severity, duration of disease, emergence of adjacent segment disc degeneration and instability.