椎间打压植骨联合棘突椎板复合体回植内固定治疗退变性腰椎不稳症

目的研究椎间打压植骨联合棘突椎板复合体回植内固定治疗退变性腰椎不稳症的手术方法,以期为临床提供一种更为理想的手术模式。方法 1998年1月-2010年10月,采用后路椎管减压、椎间打压植骨联合棘突椎板复合体回植、后路椎弓根钉棒系统内固定术治疗退变性腰椎不稳症患者48例。男26例,女22例;年龄52～76岁,平均62.4岁。病程7个月～25年,平均6.5年。单节段不稳22例,L3、41例,L4、510例,L5、S111例;多节段不稳26例,L3、4、L4、5及L5、S15例,L2、3及L3、42例,L3、4及L4、510例,L4、5及L5、S19例。合并椎间盘突出32例,椎管狭窄46例,退变性脊柱侧弯16例。手术前后采用日本骨科学会(JOA)评分、植骨椎间隙融合、椎间隙高度及腰椎前凸角变化情况评定疗效。结果患者切口均Ⅰ期愈合;术中、术后未出现神经损伤、螺钉断裂、伤口感染等并发症。48例均获随访,随访时间1～6年。植骨椎间隙融合时间12～18周,平均16.2周。脊柱滑移或退变性侧弯得到纠正,基本恢复脊柱的正常序列。术前、术后6个月及末次随访时手术节段椎间隙高度分别为(5.2±2.3)、(11.9±2.0)、(11.6±2.1)mm;JOA评分分别为(3.2±2.1)、(12.8±1.6)、(13.6±1.2)分;腰椎前凸角分别为(—20.5±10.5)、(30.5±8.5)、(31.2±5.6)°。术后各指标均较术前显著改善,差异有统计学意义(P<0.05);术后6个月与末次随访时比较差异无统计学意义(P>0.05)。术后6个月根据JOA改善率评定,获优36例,良10例,可2例,优良率95.8%。结论椎间打压植骨联合棘突椎板复合体回植内固定治疗退变性腰椎不稳症,手术方法有效可行,稳定性好,融合率高,是一种接近于解剖性重建的椎管成形术。

Lumbar interbody fusion impacted bone grafts combined with regrafting in situ with spinous process and vertebral plate complex and pedicle screw fixation for lumbar degenerative instability

Objective To evaluate the effectiveness of lumbar interbody fusion impacted bone grafts combined with regrafting in situ with spinous process and vertebral plate complex and pedicle screw xation for lumbar degenerative instability.Methods Between January 1998 and October 2010,48 patients with lumbar degenerative instability were treated by posterior decompression,lumbar interbody fusion impacted bone grafts combined with regrafting in situ with spinous process and vertebral plate complex and pedicle screw xation.There were 26 males and 22 females,aged 52-76 years(mean,62.4 years).The disease duration was 7 months to 25 years(mean,6.5 years).One segmental instability was located at L3,4in 1 case,at L4,5 in 10 cases,and at L5,S1in 11 cases;multi-segmental instability was located at L3,4,L4,5,and L5,S1in 5 cases,at L2,3and L3,4in 2 cases,at L3,4and L4,5in 10 cases,and at L4,5and L5,S1in 9 cases.Of 48 patients,32 complicated by lumbar disc herniation,46 by lumbar spinal stenosis,and 16 by degenerative scoliosis.The clinical results wereffevaluated by the Japanese Orthopaedic Association(JOA) score,recovery rate,disc height,and lumbar lordosis angles.Results The incisions obtained healing by rst intention after operation.No nerve injury,rod or screw breakage,and infection occurred during and after operation.All 48 patients were followed up 1 to 6 years.The fusion time was 12-18 weeks(mean,16.2 weeks).Vertebra slipping or degenerative scoliosis was corrected,and spinal column series became normal.At preoperation,6 months after operation,and last follow-up,the disc heights were(5.2 ± 2.3),(11.9 ± 2.0),and(11.6 ± 2.1) mm,respectively;the JOA scores were 3.2 ± 2.1,12.8 ± 1.6,and 13.6 ± 1.2,respectively;and the lumbar lordosis angles were(—20.5 ± 10.5),(30.5 ± 8.5),and(31.2 ± 5.6)°,respectively.The JOA scores,disc heights,and lumbar lordosis angles were signi cantly improved at 6 months after operation and last follow-up when compared with preoperative ones(P < 0.05),but no signi cant di erence was found between 6 months after operation and last follow-up(P > 0.05).The recovery rate of JOA was excellent in 36 cases,good in 10 cases,and fair in 2 cases at 6 months after operation,with an excellent and good rate of 95.8%.Conclusion Lumbar interbody fusion impacted bone grafts combined with regrafting in situ with spinous process and vertebral plate complex and pedicle screw xation for lumbar degenerative instability can restore and maintain the intervertebral disc height effectively with high fusion rate.It is a plasty close to anatomic reconstruction.