开窗减压椎间植骨融合内固定治疗退变性腰椎不稳

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1、开窗减压椎间植骨融合内固定治疗退变性腰椎不稳作者：王建钧　陈建庭　王素伟【摘要】：［目的］探讨开窗减压、椎间植骨融合(PLIF)内固定治疗老年退变性腰椎不稳。［方法］81例临床病人，男38例，女43例；年龄47～71岁，平均62岁；病变部位：L2、3间隙2例，L3、4间隙63例，L4、5间隙33例，L5S1间隙5例；2节段椎间融合21例，3节段椎间融合15例，4节段椎间融合2例；伴椎体Ⅰ度滑脱26例，伴有>15°侧凸的4例。术前常规摄腰椎正侧位、双斜位、腰椎过伸过屈动力位片、CT及MRI，了解椎管狭窄及椎体不稳程度；经腰椎后路行椎弓根钉棒系统内固定、开窗椎管减压、自体

2、骨及Cage椎间植骨融合手术治疗，术中行撑开、提拉，将减压的自体椎板骨质修整，颗粒状碎骨填充于Cage，块状较大的骨块植入椎间隙，术后1周带腰围或佩戴支具下床活动。［结果］本组随访时间2～4年，术后均行X线片复查，随访X线片显示椎间植骨融合良好，椎体复位无丢失，螺钉无折断和松动。手术前、后椎体滑移距离和ODI指数两项参数的配对比较差异具有显著性。［结论］椎弓根钉棒系统内固定、开窗椎管彻底减压、自体骨混合Cage椎间植骨融合是治疗退变性腰椎不稳的一种有效手术方法。【关键词】13退变性腰椎不稳　椎弓根螺钉内固定　Oswestry功能障碍指数　椎间植骨融合　　Abstract：［

3、Objective］Todiscussthemethodsoffenestrationdecompression,PLIFandinternalfixationfordegenerativelumbarinstability.［Method］Therewere81patientswithdegenerativelumbardisease.Theywere38malesand43females,agedfrom47-71yearswithanaverageof62years.Therewere2lesionsL2/3,63betweenL3/4,33betweenL3/4an

4、d5betweenL5/S1.Twentyonelesionswerefusedintwosegments,15inthreesegmentsand2infoursegments.AllofthecaseshadXrayinroutineandobliqueview,CTandMRIpreoperatively.Theyweretreatedwithfenestrationdecompression,intervertebralbonegraftingandinternalfixationfordegenerativelumbarinstabilitywithpedic

5、lescrewsandinterbodyfusionwithblockofautogenousvertebralplateboneorcagesfilledwithpatchesofbone.Mostofpatientsbeganoutofbedactivitywithwaistlineororthosisat1weekafteroperation.［Result］Thefollowupwere2to4years.Theradiographicviewsshowedgoodfusion,noshiftagainandnoscrewbreakingandlossenin

6、g.Therewassignificantdifferencebetweenpreandpostoperationspondylolishesisdistance.SowasOswestryindex.［Conclusion］Itiseffectivetohave13fenestration,internalfixationwithpediclescrewsandfusionwithblockofautogenousvertebralplateboneorcagesfilledwithpatchesofbonefordegenerativelumbarinstabilit

7、y.　Keywords：degenerativelumbarinstability；internalfixationwithpediclescrews；Oswestrydisabilityindex；posteriorlumberintervertebralfusion　　退变性腰椎疾患是中老年人常见疾病，伴有椎间盘退变和椎管狭窄，严重影响患者的生活质量，近年来日趋加重的人口老年化趋势，使该类疾病逐年增多。随着对退变性腰椎疾病引起腰腿痛认识的不断深入及椎弓根内固定技术的日益成熟，对退变性腰椎疾病的治疗取得了良好的效