经皮椎弓根螺钉双边提拉复位联合MIS-LIF治疗腰椎滑脱症

发布时间：2018-04-15 04:04

  本文选题：腰椎滑脱 + 提拉复位　； 参考：《广州医科大学》2017年硕士论文

【摘要】：目的:探讨经皮长臂椎弓根螺钉双边提拉复位技术、联合后路小切口腰椎融合术(Minimally invasive surgery-lumbar interbody fusion,MIS-LIF)治疗腰椎滑脱症临床应用技巧,评估手术安全性和早期疗效。方法:选择2013年至2016年我组收治的27例腰椎滑脱症患者——经严格的保守治疗无效,滑移的椎体无法通过体位改变复位,有或无伴椎间隙高度狭窄。其中男10例,女17例;年龄40-83岁,平均61岁;退行性腰椎滑脱11例,峡部病变性腰椎滑脱16例;L3滑脱2例,L4滑脱15例,L5滑脱10例,均为单节段滑脱;根据Meyerding分级:Ⅰ度滑脱16例,Ⅱ度滑脱10例,Ⅲ度滑脱1例。纳入治疗组的患者均严格应用经皮长臂椎弓根螺钉双边提拉复位联合MISLIF治疗。统计手术时间、出血量、术后住院时间、术中术后并发症;随访观察临床疗效(VAS、ODI评分),影像对比术前后滑脱率、椎间高度,评估滑脱复位效果,按SUK标准评估椎间融合情况。结果:手术时间203.9±34.9分钟、术中出血量206.7±39.9毫升、围手术期输血量0毫升、术后住院时间8.1±1.3天。腰痛的VAS评分由术前的7.2±0.6分下降至术后3个月随访的2.3±0.9分(P=0.00)。ODI评分由术前的62.8±6.8分下降至术后3个月随访的33.5±4.1分(P=0.00)。术前滑脱率为26.5±15.0%。术后滑脱率3.1±6.1%。复位率为91.0±16.5%。椎间隙相对高度由术前的31.5±9.6%提高至术后的43.8±7.1%(P=0.00)。术后1年随访坚强融合率29.6%,可能融合率51.9%。术中未出现神经根、马尾神经并发损伤,术中及术后随访未发现拔钉、断钉、断棒、融合器退出并发症。结论:经皮长臂椎弓根螺钉双边提拉复位联合MIS-LIF治疗腰椎滑脱症是一种安全、有效的微创手术方式。
[Abstract]:Objective: to explore the technique of bilateral lifting and reduction of pedicle screw of long arm, combined with minimally invasive surgery-lumbar interbody fusion MIS-LIFA for lumbar spondylolisthesis, and to evaluate the safety and early curative effect of the operation in the treatment of lumbar spondylolisthesis.Methods: 27 cases of lumbar spondylolisthesis admitted from 2013 to 2016 were selected. The strict conservative treatment was ineffective, and the sliding vertebral body could not be reduced by body position change, with or without high stenosis of intervertebral space.There were 10 males and 17 females, aged 40-83 years (mean 61 years), 11 cases of degenerative lumbar spondylolisthesis and 16 cases of lumbar spondylolisthesis with isthmic lesion, 2 cases with L3 spondylolisthesis and 15 cases with L4 spondylolisthesis, 10 cases with L5 spondylolisthesis, all of them were single segment spondylolisthesis.According to Meyerding classification, 16 cases were grade 鈪，

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