双节段腰椎滑脱症的手术治疗

发布时间：2019-01-25 10:20

【摘要】：目的:探讨后入路腰椎椎间融合术治疗双节段腰椎滑脱的手术疗效。方法:采用回顾性病例研究方法,收集从2009年1月至2014年1月于我院就诊并确诊为双节段腰椎滑脱症患者共20例,均采用腰椎后路椎间融合手术治疗,即后路腰椎管减压、神经根松解、滑脱椎体复位、椎体间植骨融合、椎弓根螺钉系统内固定治疗。手术前1天、术后1周、术后3个月、术后6个月及术后1年并以后每隔一年均行腰腿痛目测类比评分,使用Oswestry功能障碍指数评分问卷调查表评价临床功能恢复情况,并通过影像学检查观察滑脱椎体的复位情况、椎间隙高度变化、骨盆倾斜角、骶骨倾斜角和植骨融合情况,综合评价临床疗效。结果:20例患者术后均获随访,随访时间6个月-3年,术后目测类比评分及Oswestry功能障碍指数得分及末次随访时均较术前相对应评分降低(P0.05);术后及末次随访时椎间隙高度均较术前明显增高(P0.05),手术后及末次随访时腰椎滑移百分率、骨盆倾斜角及骶骨倾斜角均较固定前有所改善(P0.05),所有病例内固定位置良好,椎体复位满意,随访植骨融合良好,无骨性不愈合或假关节形成。结论:后路腰椎椎间融合内固定术治疗双节段腰椎滑脱症疗效满意,可有效缓解患者的腰腿痛等临床症状,该术式具有复位良好,固定牢靠,融合率高等优点,可有效恢复椎间隙及椎间孔高度,重建腰椎正常的生理曲度及脊柱-骨盆矢状面正常的生理序列,从而增加脊柱稳定性。
[Abstract]:Objective: to evaluate the effect of posterior lumbar interbody fusion for two-segment lumbar spondylolisthesis. Methods: from January 2009 to January 2014, 20 cases of double-segmental lumbar spondylolisthesis were treated by posterior lumbar interbody fusion, namely posterior lumbar decompression. Release of nerve root, reduction of spondylolisthesis, fusion of bone graft between vertebrae, internal fixation of pedicle screw system. Visual analogies of lumbago and leg pain were performed 1 day before operation, 1 week, 3 months, 6 months, 1 year and every other year after operation. The clinical function recovery was evaluated by Oswestry dysfunction index questionnaire. The reduction of spondylolisthesis, the height of intervertebral space, the angle of pelvic inclination, the angle of sacrum and the fusion of bone graft were observed by imaging examination. Results: all the 20 patients were followed up for 6 months to 3 years. The scores of visual analogue score, Oswestry dysfunction index and the corresponding score at the last follow-up were lower than those before operation (P0.05). After operation and at the last follow-up, the height of intervertebral space was significantly higher than that before operation (P0.05), and the percentage of lumbar spondylolumbar slippage, pelvic tilt angle and sacral obliquity angle were improved after operation and at the last follow-up (P0.05). All cases had good internal fixation, satisfactory reduction, good bone graft fusion, no bony nonunion or pseudoarthrosis. Conclusion: posterior lumbar interbody fusion and internal fixation is effective in the treatment of two-segment lumbar spondylolisthesis, and can effectively relieve the clinical symptoms such as low back pain and leg pain. It has the advantages of good reduction, firm fixation and high fusion rate. It can effectively restore the height of intervertebral space and intervertebral foramen, reconstruct the normal physiological curvature of lumbar vertebrae and normal physiological sequence of spine and pelvis sagittal plane, thus increase the stability of spine.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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