中国伤残医学
中國傷殘醫學
중국상잔의학
CHINESE JOURNAL OF TRAUMA AND DISABILITY MEDICINE
2014年
17期
6-8
,共3页
马纯青%闫子贵%韩勇%孙晓东%孙瑞琦
馬純青%閆子貴%韓勇%孫曉東%孫瑞琦
마순청%염자귀%한용%손효동%손서기
椎弓根钉棒系统%椎间融合器%腰椎滑脱症%内固定
椎弓根釘棒繫統%椎間融閤器%腰椎滑脫癥%內固定
추궁근정봉계통%추간융합기%요추활탈증%내고정
Pedicle screw%Anatomical threaded cage%Lumbar spondylolisthesis%Internal fixation
目的：探讨后路椎弓根螺钉内固定结合经椎间孔单枚椎间融合器（ Cage ）融合治疗腰椎滑脱症的临床疗效。方法：从2009年11月～2013年9月，共收治61例腰椎滑脱症患者。其中男性19例，女性42例；年龄42～68岁，平均54岁。按Mey-erding分级：Ⅰ度滑脱20例，Ⅱ度30例，III度11例；L3椎体滑脱6例，L4椎体30例，L5椎体25例；峡部裂性腰椎滑脱21例，退变性腰椎滑脱40例。采用后路减压，复位，椎弓根螺钉固定，经椎间孔单枚椎间融合器（ Cage）融合进行手术治疗。手术中注意保护棘突，棘间及棘上韧带，术后3天复查X片后佩带腰围下床。根据腰痛视觉模拟评分（VAS）和JOA下腰痛评分系统（15分）评价手术前、后临床症状、体征及括约肌功能进行临床效果评估。结果：术后随访3～26个月，平均11．5个月。随访X线片显示椎体间植骨融合良好，内固定系统无松动和断裂，无明显腰椎不稳征象。复位后的滑脱椎体无丢失。术前腰腿痛VAS评分8．4分，术后2．3分，术前JOA下腰痛评分系统平均8．6分，术后22分。结论：椎弓根螺钉内固定结合经椎间孔单枚椎间融合器（ Cage ）融合手术治疗腰椎滑脱症通过两侧开窗减压，既能解除神经组织的压迫，又保留了后侧韧带复合体的完整性，能有效的保护椎管内神经组织，从而在很大程度上维持了腰椎正常的生物力学基础，减少了创伤。是一种疗效确实、具有复位可靠、远期稳定性确切的手术方法，临床治疗效果满意。
目的：探討後路椎弓根螺釘內固定結閤經椎間孔單枚椎間融閤器（ Cage ）融閤治療腰椎滑脫癥的臨床療效。方法：從2009年11月～2013年9月，共收治61例腰椎滑脫癥患者。其中男性19例，女性42例；年齡42～68歲，平均54歲。按Mey-erding分級：Ⅰ度滑脫20例，Ⅱ度30例，III度11例；L3椎體滑脫6例，L4椎體30例，L5椎體25例；峽部裂性腰椎滑脫21例，退變性腰椎滑脫40例。採用後路減壓，複位，椎弓根螺釘固定，經椎間孔單枚椎間融閤器（ Cage）融閤進行手術治療。手術中註意保護棘突，棘間及棘上韌帶，術後3天複查X片後珮帶腰圍下床。根據腰痛視覺模擬評分（VAS）和JOA下腰痛評分繫統（15分）評價手術前、後臨床癥狀、體徵及括約肌功能進行臨床效果評估。結果：術後隨訪3～26箇月，平均11．5箇月。隨訪X線片顯示椎體間植骨融閤良好，內固定繫統無鬆動和斷裂，無明顯腰椎不穩徵象。複位後的滑脫椎體無丟失。術前腰腿痛VAS評分8．4分，術後2．3分，術前JOA下腰痛評分繫統平均8．6分，術後22分。結論：椎弓根螺釘內固定結閤經椎間孔單枚椎間融閤器（ Cage ）融閤手術治療腰椎滑脫癥通過兩側開窗減壓，既能解除神經組織的壓迫，又保留瞭後側韌帶複閤體的完整性，能有效的保護椎管內神經組織，從而在很大程度上維持瞭腰椎正常的生物力學基礎，減少瞭創傷。是一種療效確實、具有複位可靠、遠期穩定性確切的手術方法，臨床治療效果滿意。
목적：탐토후로추궁근라정내고정결합경추간공단매추간융합기（ Cage ）융합치료요추활탈증적림상료효。방법：종2009년11월～2013년9월，공수치61례요추활탈증환자。기중남성19례，녀성42례；년령42～68세，평균54세。안Mey-erding분급：Ⅰ도활탈20례，Ⅱ도30례，III도11례；L3추체활탈6례，L4추체30례，L5추체25례；협부렬성요추활탈21례，퇴변성요추활탈40례。채용후로감압，복위，추궁근라정고정，경추간공단매추간융합기（ Cage）융합진행수술치료。수술중주의보호극돌，극간급극상인대，술후3천복사X편후패대요위하상。근거요통시각모의평분（VAS）화JOA하요통평분계통（15분）평개수술전、후림상증상、체정급괄약기공능진행림상효과평고。결과：술후수방3～26개월，평균11．5개월。수방X선편현시추체간식골융합량호，내고정계통무송동화단렬，무명현요추불은정상。복위후적활탈추체무주실。술전요퇴통VAS평분8．4분，술후2．3분，술전JOA하요통평분계통평균8．6분，술후22분。결론：추궁근라정내고정결합경추간공단매추간융합기（ Cage ）융합수술치료요추활탈증통과량측개창감압，기능해제신경조직적압박，우보류료후측인대복합체적완정성，능유효적보호추관내신경조직，종이재흔대정도상유지료요추정상적생물역학기출，감소료창상。시일충료효학실、구유복위가고、원기은정성학절적수술방법，림상치료효과만의。
Obje ctive:To evaluate the effects of the lumbar spondylolisthesis treated by pedicle screw combined with monocage . Methods:From November 2009 to September 2013, there were 61 patients (19 men and 42 women) with lumbar spondylosisthesis. The age was between 42 to 68 with an average of 54.The preoperative pathogenesis included isthmic spondylolisthesis (n=21) and de-generative spondylolisthesis (n=40).The involved levels were L3 of 6 cases, L4 of 30 cases and L5 of 25 cases.According to Meyer-ding standard, all cases were classified into 20 cases of I degree, 30 cases of II degree and 11 cases of III degree.All patients under-went decompression, reduction, pedicle screw system fixed,and intervertebral space fusion by monocage .The clinical effects were e-valuated according to Visual Analog Scale ( VAS) and JOA scoring system.Results: All the patients were followed up from 3 to 26 months with an average of 11.5 months.All the operated segments achieved fusion standard and no broken screw or cage dislocation oc-curred.Visual Analog Scale (VAS), JOA showed statistical significance between perioperation and postoperatively ( p <0.05).Con-clusions:Applying the posterior pedicle screw internal fixation combined with interbody threaded fusion cage may achieve synergism in the treatment of lumbar vertebral spondylolisthesis.It serves as a solid internal fixation, offers a satisfactory reduction and improves the fusion rate of the spine .This is an ideal procedure and worthy of being recommended as a method for the treatment of lumbar vertebral spondaylolisthesis.
