CAJ | 학술논문

目的总结改良360°融合术式治疗腰椎滑脱的临床疗效,探讨腰椎改良360°融合术的可行性及有效性.方法选取2005年3月至2012年11月期间采用改良360°融合术治疗单节段退行性腰椎滑脱患者76例的病历资料进行回顾性分析,男26例,女50例;年龄51～74岁,平均(64.3±7.8)岁.按Meyerding分级,Ⅰ度滑脱65例,Ⅱ度滑脱11例.腰痛伴下肢疼痛55例(72.3％),腰痛伴下肢麻木16例(27.7％),均有间歇性跛行的腰椎管狭窄症表现.合并椎间盘突出33例(43.4％),椎间盘膨出43例(56.6％),黄韧带增厚58例(76.3％),关节突增生内聚65例(85.5％),侧隐窝狭窄42例(55.3％).融合器置于L3.4者2例,L4,5者64例,L5S1者10例.术前、术后6个月及术后1年随访时采用视觉模拟评分(visualanalogue scale,VAS)及日本骨科协会(Japanese Orthopaedic Association,JOA)评分对手术临床疗效进行评价.采用X线片及CT平扫加矢状重建评价融合及复位丢失情况.结果 76例患者均获至少1年随访.滑脱手术复位率为96.8％;术后6个月复位丢失率为1.1％,术后1年为0.8％,差异无统计学意义.术前与术后及末次随访时滑脱率、腰椎前凸角度、椎间盘高度、滑脱角度的差异均有统计学意义,而术后1周、6个月及1年的差异均无统计学意义.术后6个月植骨融合率为76.3％,术后1年为98.7％,差异有统计学意义.末次随访时JOA评分和VAS评分与术前比较差异均有统计学意义.术中硬脊膜撕裂1例;术后融合器沉降1例,螺钉松动1例.结论改良360°融合术治疗腰椎滑脱疗效确切,复位丢失率低,植骨融合率高,值得临床推广.
목적 총결개량360°융합술식치료요추활탈적림상료효,탐토요추개량360°융합술적가행성급유효성.방법 선취2005년3월지2012년11월기간채용개량360°융합술치료단절단퇴행성요추활탈환자76례적병력자료진행회고성분석,남26례,녀50례;년령51～74세,평균(64.3±7.8)세.안Meyerding분급,Ⅰ도활탈65례,Ⅱ도활탈11례.요통반하지동통55례(72.3％),요통반하지마목16례(27.7％),균유간헐성파행적요추관협착증표현.합병추간반돌출33례(43.4％),추간반팽출43례(56.6％),황인대증후58례(76.3％),관절돌증생내취65례(85.5％),측은와협착42례(55.3％).융합기치우L3.4자2례,L4,5자64례,L5S1자10례.술전、술후6개월급술후1년수방시채용시각모의평분(visualanalogue scale,VAS)급일본골과협회(Japanese Orthopaedic Association,JOA)평분대수술림상료효진행평개.채용X선편급CT평소가시상중건평개융합급복위주실정황.결과 76례환자균획지소1년수방.활탈수술복위솔위96.8％;술후6개월복위주실솔위1.1％,술후1년위0.8％,차이무통계학의의.술전여술후급말차수방시활탈솔、요추전철각도、추간반고도、활탈각도적차이균유통계학의의,이술후1주、6개월급1년적차이균무통계학의의.술후6개월식골융합솔위76.3％,술후1년위98.7％,차이유통계학의의.말차수방시JOA평분화VAS평분여술전비교차이균유통계학의의.술중경척막시렬1례;술후융합기침강1례,라정송동1례.결론 개량360°융합술치료요추활탈료효학절,복위주실솔저,식골융합솔고,치득림상추엄.
Objective To analyze the clinical results of 360° fusion for spondylolisthesis.Methods Data of 76 patients from March 2005 to November 2012,including 26 males and 50 females with a mean age of 54.3 years were retrospectively analyzed.All patients had undergone modified 360° fusion.The clinical outcomes were evaluated by the Japanese Orthopaedic Association scores (JOA) and visual analogue scale (VAS).The fusion status and loss of correction were assessed by CT and plain radiographs.Results All patients had been successfully followed up for at least one year.Post-operative reduction rate was 96.8％,with a mean loss rate of 1.1％ at six months and 0.8％ at one year follow-up separately,but the difference was not significant.Postoperative percentage of slip,lumbar lordosis,intervertebral disc height and slip angle had significant differences,compared with those of the pre-operative,but the difference between one week post-operative,six months follow-up and one year follow-up were not significant.The fusion rate was 76.3％ at six months follow-up and 98.7％ at one year follow-up,and there were significant differences.Both JOA and VAS score at six months and one year follow-up indicated significant differences in contrast to that of preoperative.Dural injury was found in one patient,and subsidence was found in one patient.One received a second operation at 3 months after the surgery due to screw loose.Conclusions Modified 360° fusion shows great clinical outcome and fusion rate,which can be a dominant procedure for treating spondylolisthesis.