中国骨伤
中國骨傷
중국골상
CHINA JOURNAL OF ORTHOPAEDICS AND TRAUMATOLOGY
2014年
9期
722-725
,共4页
华永均%王人彦%郭志辉%朱利民%陆建阳
華永均%王人彥%郭誌輝%硃利民%陸建暘
화영균%왕인언%곽지휘%주이민%륙건양
腰椎不稳%椎弓根钉系统%脊柱融合术%经孔椎体间融合术
腰椎不穩%椎弓根釘繫統%脊柱融閤術%經孔椎體間融閤術
요추불은%추궁근정계통%척주융합술%경공추체간융합술
Lumbar instability%Pedicle screw system%Spinal fusion%Transforaminal lumbar interbody fusion
目的：探讨经椎间孔入路单侧椎弓根钉固定结合单枚融合器治疗腰椎不稳症的临床疗效。方法：回顾性分析2009年至2012年收治且获得8个月以上随访腰椎不稳症50例，均有顽固性或反复下腰痛，有单侧或单侧为主的下肢放射痛，X线片及CT片显示腰椎不稳。采用经椎间孔入路单枚融合器椎间融合，结合单侧或双侧椎弓根钉固定治疗。根据固定方法不同，分为单侧固定组和双侧固定组。单侧固定组20例22间隙，男8例，女12例；年龄26～66岁；峡部裂性Ⅰ度滑脱2例，退行性滑脱8例，腰椎间盘突出症10例；融合部位L3，41例，L4，512例，L5S19例。双侧固定组30例30间隙，男14例，女16例；年龄41～62岁；峡部裂型Ⅰ度滑脱4例，退行性滑脱14例，腰椎间盘突出症12例；融合部位L3，43例，L4，515例，L5S112例。分析两组患者的手术时间、术中出血量、术后引流量、并发症情况，并对其椎间隙高度、前凸角的变化、融合率及临床疗效等进行比较。结果：两组患者术后切口均Ⅰ期愈合，腰痛基本消失，下肢放射痛均消失，无感染、硬脊膜损伤等发生。单侧固定组术后无医源性神经症状，双侧固定组术后1例足下垂。所有患者获得随访，时间8～18个月，平均（10．8±4．3）个月。临床疗效按照JOA评分好转率（RIS）评定，两组均获得较好临床疗效，且两组融合率比较差异无统计学意义，两种内固定治疗方法均能有效增加病变椎间隙高度。单侧固定组较双侧固定组手术时间更短，术中出血和术后引流量更少。结论：只要严格掌握手术适应证，注意手术操作技巧，经椎间孔入路单枚融合器加单侧椎弓根钉治疗腰椎不稳症具有创伤小、出血少、恢复快、经济实用等优点。
目的：探討經椎間孔入路單側椎弓根釘固定結閤單枚融閤器治療腰椎不穩癥的臨床療效。方法：迴顧性分析2009年至2012年收治且穫得8箇月以上隨訪腰椎不穩癥50例，均有頑固性或反複下腰痛，有單側或單側為主的下肢放射痛，X線片及CT片顯示腰椎不穩。採用經椎間孔入路單枚融閤器椎間融閤，結閤單側或雙側椎弓根釘固定治療。根據固定方法不同，分為單側固定組和雙側固定組。單側固定組20例22間隙，男8例，女12例；年齡26～66歲；峽部裂性Ⅰ度滑脫2例，退行性滑脫8例，腰椎間盤突齣癥10例；融閤部位L3，41例，L4，512例，L5S19例。雙側固定組30例30間隙，男14例，女16例；年齡41～62歲；峽部裂型Ⅰ度滑脫4例，退行性滑脫14例，腰椎間盤突齣癥12例；融閤部位L3，43例，L4，515例，L5S112例。分析兩組患者的手術時間、術中齣血量、術後引流量、併髮癥情況，併對其椎間隙高度、前凸角的變化、融閤率及臨床療效等進行比較。結果：兩組患者術後切口均Ⅰ期愈閤，腰痛基本消失，下肢放射痛均消失，無感染、硬脊膜損傷等髮生。單側固定組術後無醫源性神經癥狀，雙側固定組術後1例足下垂。所有患者穫得隨訪，時間8～18箇月，平均（10．8±4．3）箇月。臨床療效按照JOA評分好轉率（RIS）評定，兩組均穫得較好臨床療效，且兩組融閤率比較差異無統計學意義，兩種內固定治療方法均能有效增加病變椎間隙高度。單側固定組較雙側固定組手術時間更短，術中齣血和術後引流量更少。結論：隻要嚴格掌握手術適應證，註意手術操作技巧，經椎間孔入路單枚融閤器加單側椎弓根釘治療腰椎不穩癥具有創傷小、齣血少、恢複快、經濟實用等優點。
목적：탐토경추간공입로단측추궁근정고정결합단매융합기치료요추불은증적림상료효。방법：회고성분석2009년지2012년수치차획득8개월이상수방요추불은증50례，균유완고성혹반복하요통，유단측혹단측위주적하지방사통，X선편급CT편현시요추불은。채용경추간공입로단매융합기추간융합，결합단측혹쌍측추궁근정고정치료。근거고정방법불동，분위단측고정조화쌍측고정조。단측고정조20례22간극，남8례，녀12례；년령26～66세；협부렬성Ⅰ도활탈2례，퇴행성활탈8례，요추간반돌출증10례；융합부위L3，41례，L4，512례，L5S19례。쌍측고정조30례30간극，남14례，녀16례；년령41～62세；협부렬형Ⅰ도활탈4례，퇴행성활탈14례，요추간반돌출증12례；융합부위L3，43례，L4，515례，L5S112례。분석량조환자적수술시간、술중출혈량、술후인류량、병발증정황，병대기추간극고도、전철각적변화、융합솔급림상료효등진행비교。결과：량조환자술후절구균Ⅰ기유합，요통기본소실，하지방사통균소실，무감염、경척막손상등발생。단측고정조술후무의원성신경증상，쌍측고정조술후1례족하수。소유환자획득수방，시간8～18개월，평균（10．8±4．3）개월。림상료효안조JOA평분호전솔（RIS）평정，량조균획득교호림상료효，차량조융합솔비교차이무통계학의의，량충내고정치료방법균능유효증가병변추간극고도。단측고정조교쌍측고정조수술시간경단，술중출혈화술후인류량경소。결론：지요엄격장악수술괄응증，주의수술조작기교，경추간공입로단매융합기가단측추궁근정치료요추불은증구유창상소、출혈소、회복쾌、경제실용등우점。
Objective:To explore the clinical effect of transforaminal lumbar interbody fusion (with single cage) combined with unilateral pedicle screw fixation in treating lumbar instability. Methods:The clinical data of 50 patients with lumbar in-stability were retrospectively analyzed. They underwent treatment and obtained following up more than 8 months from 2009 to 2012. All patients complicated with refractory or recurrent lower back pain ,and unilateral primarily or unilateral lower limb ra-diation pain,X ray and CT films showed lumbar instability. The patients were respectively treated with transforaminal lumbar interbody fusion (with single cage) combined with unilateral or bilateral pedicle screw fixation. According to different fixation methods,they divided into unilateral fixation group and bilateral fixation group. There were 20 patients with 22 intervertebral spaces in unilateral fixation group,8 males and 12 females,aged from 26 to 66 years old,2 cases with isthmic spondylolisthesis of degreeⅠ,8 cases with degenerative spondylolisthesis,10 cases with lumbar disc herniation;fusion location with L3,4 was in 1 case,L4,5 was in 12 cases,L5S1 was in 9 cases. There were 30 patients with 30 intervertebral spaces in bilateral fixation group,14 males and 16 females,aged from 41 to 62 years old,4 cases with isthmic spondylolisthesis of degree Ⅰ,14 cases with degenerative spondylolisthesis,12 cases with lumbar disc herniation;fusion location with L3,4 was in 3 cases,L4,5 was in 15 case,L5S1 was in 12 cases. Operation time,intraoperative blood loss,postoperative drainage,complications were analyzed and intervertebral height,lordosis angle changes,fusion rate and clinical effect were compared between two groups. Results:All incisions obtained primary healing,lower limb radiation pain and low back pain disappeared basically,no infection,endo-rachis injury was found. Foot drop occurred in one case of bilateral fixation group and no iatrogenic neurological symptom was found in unilateral fixation group. All patients were followed up from 8 to 18 months with an average of (10.8±4.3)months. Ac-cording to JOA score improvement rate (RIS) to assess clinical effect,all patients got excellent and good results,there was no statistically significant difference between two groups. Two methods can both effectively increase the pathological intervertebral height. Unilateral fixation group was better than bilateral fixation group in aspect of operation time ,intraoperative blood loss and postoperative drainage. Conclusion:With strict indication and good skills,transforaminal lumbar interbody fusion (with single cage) combined with unilateral pedicle screw fixation in treating lumbar instability has advantages of smaller traumatic , less blood loss,faster recovery for the patient and can reduce the economic cost.
