腰椎后外侧融合术治疗退行性腰椎管狭窄症的近期疗效观察

Therapeutic effect of posterolateral lumbar fusion with pedicle screw system for degenerative lumbar spinal stenosis

关键词:  腰椎管狭窄症  退变性  后外侧融合  内固定  临床疗效

Key words:  lumbar spinal stenosis  degenerative  posterolateral fusion  internal fixation  clinical effect

摘要:

目的 探讨腰椎后外侧融合术疗退行性腰椎狭窄症的临床疗效。方法 回顾性分析2007年1月—2008年6月采用腰椎后外侧融合、椎弓根钉系统内固定手术治疗退行性腰椎狭窄症。其中男33例，女38例；年龄41-82岁；病程7个月~30年。发病节段：单节段L4-56例，L-S1 2例；两节段L4-S1 19例、L3-5 22例；三节段L2-57例、L3-S1 12例；四节段L1-5例；腰椎管狭窄合并腰椎滑脱、不稳定性腰椎节段：L4-5 6例、L5-S1 2例。患者均为初次手术。疗效采用JOA下腰痛评分标准及植骨融合标准，观察及记录患者功能改善恢复情况及融合情况，评价临床治疗效果。结果 71例均获得随访，时间15—40个月。最近一次随访JOA改善率为：优：42例；良：22例、可7例；优良率达90．1%。所有节段均获得融合。结论 PLF是治疗退行陛腰椎狭窄症的一种安全、有效的手术方式，手术时间短，出血量少，骨融合率高，并发症少。

Abstract:

Objective To study the therapeutic effect of posterolateral fusion（PLF） on the treatment of degenerative lumbar spinal stenosis.Methods Seventy-one patients with degenerative lumbar spinal stenosis,including 33 males and 38 females aged from 41 to 82 years with an average of 67,were treated by posterolateral fusion from Jan.2007 to Jun.2008.The invasional segments were L_4-5 in 6 cases,L₅-S₁ in 12 cases,L₄-S₁ in 19 cases,L_3-5 in 22 cases,L_2-5 in 7 cases,L₃-S₁ in 12 cases,and L_1-5 in 5 cases.All patients received the decompression of spinal canal and short/long segment pedicle fixation.Patients were followed up for 15-40 months after operation.The operating time,the hemorrhage,the bone fusion rate,the neural function according to JOA score and complications were recorded and the short period effect was evaluated.Results All cases were regularly followed up.The follow-up period was 15-40 months.The JOA scores were excellent in 42 cases,good in 22 cases,fair in 7 cases with a good-excellent rate of 90.1%.The bone fusion rate was 100%.Conclusion PLF for degenerative lumbar spinal stenosis can effectively raise the clinical improvement rate and reduce the occurrence of complications.