摘要
目的:比较椎管减压、椎弓根螺钉辅助横突间植骨融合和椎管减压、椎弓根螺钉辅助后路Cage椎间植骨融合治疗退变性腰椎管狭窄伴腰椎滑脱的早期疗效。方法:回顾性分析2004年3月至2008年3月我院采用椎管减压、椎弓根螺钉辅助横突间植骨融合治疗的18例(Ⅰ组)及采用椎弓根螺钉辅助后路Cage椎间植骨融合治疗的14例(Ⅱ组)退变性腰椎管狭窄伴腰椎滑脱患者的病历资料,从患者的腰椎功能改善情况、植骨融合情况、术中情况及并发症发生情况等方面进行比较。结果:①2组患者术前、术后1年及术后1年与术前JOA评分差值比较,差异均无统计学意义(t=1.101,P=0.280;t=0.462,P=0.563;t=0.585,P=0.883)。②Ⅰ组16例患者植骨融合2,例未融合;Ⅱ组患者植骨全部融合。2组间植骨融合情况比较,差异无统计学意义(P=0.492)。③Ⅰ组患者术中出血量及手术时间均少于Ⅱ组,差异有统计学意义(t=9.269,P=0.000;t=35.957,P=0.000);Ⅰ组2例出现下肢麻木,3例发生硬膜撕裂,Ⅱ组5例出现下肢麻木,6例发生硬膜撕裂2,组并发症发生情况比较,差异无统计学意义(P=0.195,P=0.132)。结论:对于退变性腰椎管狭窄伴腰椎滑脱患者,行椎管减压、椎弓根螺钉固定后采用横突间植骨融合与Cage椎间融合2种植骨方式疗效相当,但采用后路Cage椎间植骨融合创伤较大,手术时间长,失血量大。对伴有Ⅰ、Ⅱ度滑脱者,只要术中正确处理植骨床、充分植骨,横突间融合不失为首选方案。
Objective：To compare the early curative effects of vertebral canal decompression plus intertransverse bone fusion with support from pedicle screw with that of vertebral canal decompression plus posterior lumbar interbody fusion with support from Cage and pedicle screw on degenerative lumbar spinal stenosis（DLSS） combined with degenerative lumbar spondylolisthesis（DLS）.Methods：The medical records of 32 DLSSDLS patients treated in our hospital from march 2004 to march 2008 were analyzed retrospectively.18 cases in groupⅠwere treated through vertebral canal decompression plus intertransverse bone fusion with support from pedicle screw,while the others in groupⅡwere treated through vertebral canal decompression plus posterior lumbar interbody fusion with support from Cage and pedicle screw.Some indexes were compared between the 2 groups to evaluated the improvement of lumbar function,effect of the bone graft fusion,intraoperative conditions and complications.Results：①There was no statistical difference of JOA scores between the 2 groups before operation and 1 year after operation,so did the difference of preoperative JOA scores and JOA scores 1 year after the operation（t=1.101,P=0.280;t=0.462,P=0.563;t=0.585,P=0.883）.②16 patients achieved successful bone graft fusion in groupⅠand the other 2 patients encountered failure,while no abortive cases were found in groupⅡ.There was no statistical difference in effect of the bone graft fusion between the 2 groups（P=0.492）.③Amount of blood loss and operation time of patients in groupⅠwere lower than those of patients in groupⅡ（t=9.269,P=0.000;t=35.957,P=0.000）.In groupⅠ,numbness of lower limb occurred in 2 cases and dural tear occurred in 3 cases;while in groupⅡ,the above 2 complications occured in 5 and 6 cases respectively;there was no statistical difference in ratio of complications between the 2 groups（P=0.195,P=0.132）.Conclusion：Compared with the method of vertebral canal decompression plus intertransverse bone fusion with support from pedicle screw,the method of vertebral canal decompression plus posterior lumbar interbody fusion with support from Cage and pedicle screw has approximate curative effect on DLSS combined with DLS,but the latter method has the disadvantages as more severe injury,longer duration of operation and more intraoperation blood loss.Therefore,the former method is regarded as the preferred solution to DLSS combined with DLS ofⅠandⅡdegree so far as such measures are taken as correct handling of grafting bed and sufficient bone graft during the operation.
出处
《中医正骨》
2011年第3期19-22,共4页
The Journal of Traditional Chinese Orthopedics and Traumatology
关键词
椎管狭窄
脊椎滑脱
腰椎
脊柱融合术
Spinal stenosis
Spondylolysis
Lumbar vertebrae
Spinal fusion
