本文選題：腰椎滑脫 + 提拉復位　； 參考：《廣州醫(yī)科大學》2017年碩士論文

【摘要】：目的:探討經(jīng)皮長臂椎弓根螺釘雙邊提拉復位技術(shù)、聯(lián)合后路小切口腰椎融合術(shù)(Minimally invasive surgery-lumbar interbody fusion,MIS-LIF)治療腰椎滑脫癥臨床應(yīng)用技巧,評估手術(shù)安全性和早期療效。方法:選擇2013年至2016年我組收治的27例腰椎滑脫癥患者——經(jīng)嚴格的保守治療無效,滑移的椎體無法通過體位改變復位,有或無伴椎間隙高度狹窄。其中男10例,女17例;年齡40-83歲,平均61歲;退行性腰椎滑脫11例,峽部病變性腰椎滑脫16例;L3滑脫2例,L4滑脫15例,L5滑脫10例,均為單節(jié)段滑脫;根據(jù)Meyerding分級:Ⅰ度滑脫16例,Ⅱ度滑脫10例,Ⅲ度滑脫1例。納入治療組的患者均嚴格應(yīng)用經(jīng)皮長臂椎弓根螺釘雙邊提拉復位聯(lián)合MISLIF治療。統(tǒng)計手術(shù)時間、出血量、術(shù)后住院時間、術(shù)中術(shù)后并發(fā)癥;隨訪觀察臨床療效(VAS、ODI評分),影像對比術(shù)前后滑脫率、椎間高度,評估滑脫復位效果,按SUK標準評估椎間融合情況。結(jié)果:手術(shù)時間203.9±34.9分鐘、術(shù)中出血量206.7±39.9毫升、圍手術(shù)期輸血量0毫升、術(shù)后住院時間8.1±1.3天。腰痛的VAS評分由術(shù)前的7.2±0.6分下降至術(shù)后3個月隨訪的2.3±0.9分(P=0.00)。ODI評分由術(shù)前的62.8±6.8分下降至術(shù)后3個月隨訪的33.5±4.1分(P=0.00)。術(shù)前滑脫率為26.5±15.0%。術(shù)后滑脫率3.1±6.1%。復位率為91.0±16.5%。椎間隙相對高度由術(shù)前的31.5±9.6%提高至術(shù)后的43.8±7.1%(P=0.00)。術(shù)后1年隨訪堅強融合率29.6%,可能融合率51.9%。術(shù)中未出現(xiàn)神經(jīng)根、馬尾神經(jīng)并發(fā)損傷,術(shù)中及術(shù)后隨訪未發(fā)現(xiàn)拔釘、斷釘、斷棒、融合器退出并發(fā)癥。結(jié)論:經(jīng)皮長臂椎弓根螺釘雙邊提拉復位聯(lián)合MIS-LIF治療腰椎滑脫癥是一種安全、有效的微創(chuàng)手術(shù)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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