【摘要】：目的:探討后入路腰椎椎間融合術(shù)治療雙節(jié)段腰椎滑脫的手術(shù)療效。方法:采用回顧性病例研究方法,收集從2009年1月至2014年1月于我院就診并確診為雙節(jié)段腰椎滑脫癥患者共20例,均采用腰椎后路椎間融合手術(shù)治療,即后路腰椎管減壓、神經(jīng)根松解、滑脫椎體復(fù)位、椎體間植骨融合、椎弓根螺釘系統(tǒng)內(nèi)固定治療。手術(shù)前1天、術(shù)后1周、術(shù)后3個(gè)月、術(shù)后6個(gè)月及術(shù)后1年并以后每隔一年均行腰腿痛目測(cè)類比評(píng)分,使用Oswestry功能障礙指數(shù)評(píng)分問卷調(diào)查表評(píng)價(jià)臨床功能恢復(fù)情況,并通過影像學(xué)檢查觀察滑脫椎體的復(fù)位情況、椎間隙高度變化、骨盆傾斜角、骶骨傾斜角和植骨融合情況,綜合評(píng)價(jià)臨床療效。結(jié)果:20例患者術(shù)后均獲隨訪,隨訪時(shí)間6個(gè)月-3年,術(shù)后目測(cè)類比評(píng)分及Oswestry功能障礙指數(shù)得分及末次隨訪時(shí)均較術(shù)前相對(duì)應(yīng)評(píng)分降低(P0.05);術(shù)后及末次隨訪時(shí)椎間隙高度均較術(shù)前明顯增高(P0.05),手術(shù)后及末次隨訪時(shí)腰椎滑移百分率、骨盆傾斜角及骶骨傾斜角均較固定前有所改善(P0.05),所有病例內(nèi)固定位置良好,椎體復(fù)位滿意,隨訪植骨融合良好,無骨性不愈合或假關(guān)節(jié)形成。結(jié)論:后路腰椎椎間融合內(nèi)固定術(shù)治療雙節(jié)段腰椎滑脫癥療效滿意,可有效緩解患者的腰腿痛等臨床癥狀,該術(shù)式具有復(fù)位良好,固定牢靠,融合率高等優(yōu)點(diǎn),可有效恢復(fù)椎間隙及椎間孔高度,重建腰椎正常的生理曲度及脊柱-骨盆矢狀面正常的生理序列,從而增加脊柱穩(wěn)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.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R687.3

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