CAJ | 학술논문

目的探讨撑开椎间隙后椎弓根钉-棒系统复位、固定的方法在治疗Ⅲ、Ⅳ度腰椎滑脱的临床价值与疗效.方法 1999年3月至2006年5月,应用全椎板减压,用椎间撑开器撑开椎间隙后,再进行椎弓根钉-棒系统复位和固定治疗重度腰椎滑脱症22例,Ⅲ度滑脱14例,Ⅳ度滑脱8例.对所有病例进行定期随访,评估滑脱率、滑脱角、骶骨倾斜角和椎间隙后高等影像学指标,并采用临床Oswestry功能障碍评分评估临床疗效.结果术后所有患者滑脱均有不同程度地复位:滑脱率由术前75.7%±3.2%恢复至术后1周12.4%±3.1%,末次随访为12.6%±3.2%;滑脱角由术前23.6°±3.9°改善至术后1周4.7°±0.5°,末次随访为4.8°±0.5°.滑脱率、滑脱角术前与术后比较差异均有统计学意义(P＜0.01),术后与末次随访比较差异均无统计学意义(P＞0.05).所有病例术后1年薄层螺旋CT扫描三维重建可见完全的骨小梁连接,达到骨性融合.临床Oswestry功能障碍评分由术前的平均(34.6±4.3)分降至术后12个月的平均(18.7±4.6)分,结果优良.2例术后神经根损伤症状经对症治疗后恢复,无其他并发症.结论椎间隙撑开能方便有效地复位椎体滑脱和恢复腰椎的生理平衡,是治疗Ⅲ、Ⅳ度腰椎滑脱症的有效策略之一.
목적 탐토탱개추간극후추궁근정-봉계통복위、고정적방법재치료Ⅲ、Ⅳ도요추활탈적림상개치여료효.방법 1999년3월지2006년5월,응용전추판감압,용추간탱개기탱개추간극후,재진행추궁근정-봉계통복위화고정치료중도요추활탈증22례,Ⅲ도활탈14례,Ⅳ도활탈8례.대소유병례진행정기수방,평고활탈솔、활탈각、저골경사각화추간극후고등영상학지표,병채용림상Oswestry공능장애평분평고림상료효.결과 술후소유환자활탈균유불동정도지복위:활탈솔유술전75.7%±3.2%회복지술후1주12.4%±3.1%,말차수방위12.6%±3.2%;활탈각유술전23.6°±3.9°개선지술후1주4.7°±0.5°,말차수방위4.8°±0.5°.활탈솔、활탈각술전여술후비교차이균유통계학의의(P＜0.01),술후여말차수방비교차이균무통계학의의(P＞0.05).소유병례술후1년박층라선CT소묘삼유중건가견완전적골소량련접,체도골성융합.림상Oswestry공능장애평분유술전적평균(34.6±4.3)분강지술후12개월적평균(18.7±4.6)분,결과우량.2례술후신경근손상증상경대증치료후회복,무기타병발증.결론 추간극탱개능방편유효지복위추체활탈화회복요추적생리평형,시치료Ⅲ、Ⅳ도요추활탈증적유효책략지일.
Objective To study the clinical results of intervertebral disc space distraction reduction associating with posterior lumbar interbody fusion and posterior compression in treating grades Ⅲ and Ⅳ spondylolisthesis in adults.Methods A total of 22 adulis patients with Ⅲ and Ⅳ spondylolistbesis underwent the procedure of decompressive laminectomy,primary reduction using intervertebral disc space distraction,interbody fusion with insert cages and local morselized bone,and posterior monosegmental compression instrumentation with pedicular fixation.The clinical outcomes were evaluated according to Oswestry disability questionnaire,and the radiographic data included slipping degree,slipping angle,sacral inclination.and posterior height of intervertebral disc.Thin-section helical computed tomography(CT)scanning was used to assess the interbody fusion.Results Follow-up ranged from 1 to 7 years.Slip improved from 75.7%±3.2%to 12.4%±3.1%at 1 week postoperatively and 12.6%±3.2%at final follow-up.Slipping angle from 23.6°±3.9°to 4.7°±0.5°at 1 week postoperatively and 4.8°±0.5°at final follow-up.Sacral inclination improved from 34.8°±4.0°to 48.3°±4.4°at 1 week postoperatively.The posterior heights of intervertebral space increased from 2.8±0.5 mm to 9.5±0.9 mm at 1 week postoperatively.There were statistical difference of slip and slipping angle between preoperative and 1 week postoperatively(P＜0.01),and no statistical difference between 1 week postoperatively and final follow-up(P＞0.05).There were no significant neurologic or infectious complications.There were no overt instrumentation failures.solid bony fusion could be obtained by assessment of thin-section helical computed tomography(CT)scanning in all patients.The objective clinical outcomes of the Oswestry disability questionnaire were in average 34.6±4.3 before operation and 18.7±4.6 at 12 months postoperatively.Conclusion The modified procedure as described can provide nearanatomic correction of high-grade spendylolisthesis throush simple steps,without significant complications.