CAJ | 학술논문

目的:观察椎弓根螺钉"双皮质"固定技术在老年人腰椎滑脱及腰椎失稳症中应用的可行性和疗效.方法:随机抽取2003-06/2008-06来哈尔滨医科大学第一临床学院就诊行腰椎CT检查的患者,测量椎弓根水平椎体前缘与腹主动脉、下腔静脉或髂血管之间的距离,统计60岁以上人群与60岁以下人群指标的差异.利用椎弓根螺钉"双皮质"固定技术对哈尔滨医科大学第一临床学院骨科收治的腰椎失稳性疾病患者82例进行治疗,男35例,女47例,年龄51-75岁,平均65岁.治疗过程中严格要求钉的远端突破椎体前方皮质一个螺纹.按Macnab腰腿痛评价标准进行功能评估.结果:60岁以上老年人椎体前缘和前方血管之间的距离与60岁以下相比,差异具有显著性意义(P<0.05):82例患者均顺利完成内固定,平均时间为145 min,平均出血量530 mL.其中获得随诊病例共计43例,男15例,女28例,年龄53-75岁,平均62岁,随访时间3~53个月,平均18个月.术中出现硬膜囊破裂1例,经术中修补无后遗症,未出现任何血管损伤并发症,一过性下肢麻木疼痛3例,经治疗2个月内均缓解,无术后神经根损伤.全部患者切口均一期愈合.43例患者腰腿痛得到不同程度改善,按Macnab标准进行评价:优31例,良10例,可2例,优良率97%.结论:应用椎弓根螺钉"双皮质"固定技术在老年人腰椎滑脱及腰椎失稳症中来增加稳定性是可行且安全的.
목적:관찰추궁근라정"쌍피질"고정기술재노년인요추활탈급요추실은증중응용적가행성화료효.방법:수궤추취2003-06/2008-06래합이빈의과대학제일림상학원취진행요추CT검사적환자,측량추궁근수평추체전연여복주동맥、하강정맥혹가혈관지간적거리,통계60세이상인군여60세이하인군지표적차이.이용추궁근라정"쌍피질"고정기술대합이빈의과대학제일림상학원골과수치적요추실은성질병환자82례진행치료,남35례,녀47례,년령51-75세,평균65세.치료과정중엄격요구정적원단돌파추체전방피질일개라문.안Macnab요퇴통평개표준진행공능평고.결과:60세이상노년인추체전연화전방혈관지간적거리여60세이하상비,차이구유현저성의의(P<0.05):82례환자균순리완성내고정,평균시간위145 min,평균출혈량530 mL.기중획득수진병례공계43례,남15례,녀28례,년령53-75세,평균62세,수방시간3~53개월,평균18개월.술중출현경막낭파렬1례,경술중수보무후유증,미출현임하혈관손상병발증,일과성하지마목동통3례,경치료2개월내균완해,무술후신경근손상.전부환자절구균일기유합.43례환자요퇴통득도불동정도개선,안Macnab표준진행평개:우31례,량10례,가2례,우량솔97%.결론:응용추궁근라정"쌍피질"고정기술재노년인요추활탈급요추실은증중래증가은정성시가행차안전적.
OBJECTIVE: To investigate feasibility and effectiveness of pedicle screw bi-cortical fixation in lumbar spondylolisthesis or destabilization of aged people. METHODS: The statistical significance of the distance between the anterior edge of vertebral body and the anterior major blood vessels at the level of pediculus arcus vertebrae by CT scan at random were measured and analyzed. 82 cases of lumbar spondylolisthesis or destabilization, aged 65 years (range 51 to 75 years), including 35 males and 47 females, were treated pedicle screw bi-cortical fixation, with the anterior edge of the vertebral body penetrated by one screw thread. The function was evaluated by Macnab backleg pain scale standards. RESULTS: There was significant difference in the distance of the anterior edge and the major vessels between the old and the young (P< 0.05). All the 82 cases were operated successfully, and the mean time was 145 minutes and the mean amount of bleeding was 530 mL. The 43 cases including 15 males and 28 females were followed up for 18 months (range 3 to 53 months). There was one case of rupture of the spinal dura mater with no sequela after the suture. There were 3 cases of transient paralysis and pain of lower limbs, which were alleviated after 2 months' treatment. No complications of nerve root or vessel injuries were found. All incisions healed well at the primary stage. The lumbocrural pain of all 43 cases was alleviated to a certain content. There were 31 cases of excellent, 10 of good, and 2 of fair; the excellent and good rate was 97%. CONCLUSION: It is feasible and safe to treat the lumbar spondylolisthesis or destabilization in the old with the pedicle screw bi-cortical fixation.