PLIF治疗退行性腰椎滑脱症的临床疗效

发布时间：2018-02-21 12:09

  本文关键词： 后路椎间融合 退行性腰椎滑脱 相对椎间高度　出处：《苏州大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的:评价经后路腰椎管减压椎弓根内固定椎间融合术治疗退行性腰椎滑脱伴椎管狭窄症的临床疗效。方法:对2013年2月至2014年10月收入苏州大学附属第二医院骨外科的35例退行性腰椎滑脱伴椎管狭窄症的患者(平均年龄55.78±10.12岁,其中男性8例,女性27例,I度滑脱28例,II度滑脱7例,滑脱节段均为L4-5),行后路椎管减压椎间融合(posterior lumbar interbody fusion PLIF)+椎弓根内固定术治疗,对患者进行手术后随访,随访时间为术后1个月、6个月、12个月。记录患者手术前、术后1个月、6个月、12个月按日本骨科协会(Japanese Orthopaedic Association JOA)评分和Oswestry功能障碍指数(Oswestry disability index ODI)来评估疼痛缓解及功能改善情况;影像学通过X线检查测量患者手术前后滑脱率、滑脱节段及邻近节段相对椎间隙高度,滑脱节段前凸角(Segmental Lordosis,SL),观察末次随访时的融合节段骨性愈合情况,通过比较手术前后滑脱率,相对椎间高度及SL来评价影像学改善情况。所有数据采用SPSS17.0统计学分析。结果:35例患者均顺利完成手术,平均手术时间为129.2±26.6min;平均出血量469.6±106.3ml,其中1例发生硬脊膜破裂,3例出现神经根牵扯痛,经对症治疗均治愈。患者术后1个月、6个月及12个月的JOA评分分别为23.33±2.06、24.19±2.34、25.14±2.33,与术前15.24±2.97相比均显著提高,差异有统计学意义(P0.01);优17例,良15例,可3例,差0例,优良率为91.4%;ODI评分分别为:15.36±5.36、10.12±5.18、10.06±5.31,较术前43.05±7.26均明显降低,差异有统计学意义(P0.01),术后6天的相对椎间隙高度12.2±2.0mm与术前10.6±2.3mm比较有明显增加(P0.05),与术后各时间点比较变化不大(P0.05),滑脱率术后6天0.11±0.03与术前0.36±0.05比较,差异有统计学意义(P0.05),与术后各时间点比较变化不大(P0.05),SL术后6天5.1±1.6与术前6.2±1.8比较差异明显(P0.05),与末次随访5.0±1.5比较变化不大(P0.05)。随访期间无内固定器械松动、断裂、融合器移位、不融合及邻近节段退变(ASD)等并发症。结论:经后路椎管减压椎弓根内固定椎间融合术治疗伴有椎管狭窄症状的腰椎滑脱症是一种有效的治疗方式。
[Abstract]:Objective: To evaluate the clinical efficacy of posterior lumbar canal decompression and pedicle screw fixation and interbody fusion for degenerative lumbar spondylolisthesis with spinal stenosis. Methods: 35 cases of degenerative lumbar spondylolisthesis from February 2013 to October 2014 the income of The Second Hospital Affiliated to Suzhou University bone surgery with spinal stenosis patients (mean age 55.78 + 10.12 years, including 8 cases of male, female 27 cases. I spondylolisthesis in 28 cases, 7 cases of II spondylolisthesis, slippage section was L4-5), posterior decompression and interbody fusion (posterior lumbar interbody fusion PLIF) + pedicle fixation. The patients were followed up after operation, the follow-up time was 1 months after surgery, 6 months, 12 months. Records of patients before surgery, 1 months after surgery, 6 months, 12 months in Japan (Japanese Orthopaedic Association JOA Department of orthopedics Association) scores and Oswestry disability index (Oswestry disability index ODI) to assess Pain relief and functional improvement; imaging by X-ray measurement in patients with spondylolisthesis rate before and after surgery, spondylolisthesis segment and adjacent segment relative slippage of intervertebral height and segmental lordosis (Segmental Lordosis, SL), at the end of the follow-up observation fusion segment bone healing, by comparing the rate of detachment before and after operation, the relative the intervertebral height and SL to evaluate the radiographic improvement. All data using SPSS17.0 statistical analysis. Results: 35 patients were successfully operated, the average operation time was 129.2 + 26.6min; the average amount of bleeding was 469.6 + 106.3ml, 1 cases of dural rupture, 3 cases of nerve root pain, symptomatic treatment cured. 1 months after surgery, 6 months and 12 months JOA score were 23.33 + 2.06,24.19 + 2.34,25.14 + 2.33, 15.24 + 2.97 compared with before operation were significantly increased, the difference was statistically significant (P0.01); 17 cases were excellent, 15 good 渚，

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