CAJ | 학술논문

目的：探讨后路减压、椎弓根钉固定、横突间植骨联合Cage椎间植骨融合术治疗老年性腰椎滑脱并椎管狭窄的手术方法及其疗效。方法对老年性腰椎滑脱并椎管狭窄患者47例均施行后路减压、椎弓根钉固定、横突间植骨联合Cage椎间植骨融合术。观察手术时间、出血量、并发症情况，随访复位情况。结果手术时间110～245（121．0±30．1）min；失血量278～1200（415±75．2）ml。单纯硬脊膜撕裂2例，术中给予修补。术后卧床期间并发肺部感染1例，给予治疗后痊愈。47例患者均获得随访，随访时间12～36（21．5±9．8）月，术后1年X线片显示47例滑脱复位满意，Ⅰ度滑脱者8例复位达100％（8／8），Ⅱ度滑脱者33例复位达90．9％（30／33），Ⅲ度滑脱者6例复位达66．7％（4／6）。47例中钉棒系统位置满意，Cage无下沉及移位。椎旁植骨融合中，有3例不融合。术前JOA评分8～15（12．3±2．6）分；术后JOA评分19～26（23．1±3．2）分；改善率57％～84％，平均改善率（71．3±6．8）％。结论后路减压、椎弓根钉固定、横突间植骨联合Cage椎间植骨融合术治疗老年性腰椎滑脱并椎管狭窄疗效肯定。
목적：탐토후로감압、추궁근정고정、횡돌간식골연합Cage추간식골융합술치료노년성요추활탈병추관협착적수술방법급기료효。방법대노년성요추활탈병추관협착환자47례균시행후로감압、추궁근정고정、횡돌간식골연합Cage추간식골융합술。관찰수술시간、출혈량、병발증정황，수방복위정황。결과수술시간110～245（121．0±30．1）min；실혈량278～1200（415±75．2）ml。단순경척막시렬2례，술중급여수보。술후와상기간병발폐부감염1례，급여치료후전유。47례환자균획득수방，수방시간12～36（21．5±9．8）월，술후1년X선편현시47례활탈복위만의，Ⅰ도활탈자8례복위체100％（8／8），Ⅱ도활탈자33례복위체90．9％（30／33），Ⅲ도활탈자6례복위체66．7％（4／6）。47례중정봉계통위치만의，Cage무하침급이위。추방식골융합중，유3례불융합。술전JOA평분8～15（12．3±2．6）분；술후JOA평분19～26（23．1±3．2）분；개선솔57％～84％，평균개선솔（71．3±6．8）％。결론후로감압、추궁근정고정、횡돌간식골연합Cage추간식골융합술치료노년성요추활탈병추관협착료효긍정。
Objective To analysis the clinical effect of posterior decompression and internal fixation and bone grafting in elderly lumbar spondylolisthesis combined with spinal stenosis .Methods Selected 47 cases patients with elderly lumbar spondylolisthesis and spinal stenosis , addopted posterior decompression , pedicle fixation , posterolateral graft interbody fusion joint cage,lumbar spondylolisthesis,spinal stenosis.Observe the operation time,blood loss,complications,follow-reattachment. Results The operation time was(121+30.1)min,blood loss was 278~1200(415+75.2)ml.2 cases of dural tear alone,re-paired by surgery.One case of lung infection,recovered after treatment.47 patients were followed up,12 ~36(21.5+9.8) months follow-up period.1 year after X ray showed 47 cases of spondylolisthesis satisfaction .Ⅰspondylolisthesis were all reset (8/8).Ⅱdegree spondylolisthesis were 33 cases,reset up 90.9%(30/33).Three were six cases of spondylolisthesis ,reset up 66.7%(4/6).In 47 cases of pedicle screw position satisfaction ,Cage without sinking and displacement .3 cases of nonunion paraspinal.Preoperative JOA score 8~15(12.3+2.6)score,postoperative JOA score was 19~26(21.3+3.2) score.Im-provement rate of 57%to 84%.The average improvement rate was (73.1+6.8)%.Conclusion Posterior decompression and internal fixation and bone grafting in elderly lumbar spondylolisthesis combined with spinal stenosis has an good effect .