| 三椎体复位固定行腰椎滑脱翻修手术探讨 |
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Received:December 03, 2013
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| 期刊信息：《中国骨伤》2014年27卷，第9期，第717-721页 |
| DOI：10.3969/j.issn.1003-0034.2014.09.003 |
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目的：分析腰椎滑脱症手术失败原因，探讨三椎体复位固定翻修腰椎滑脱症手术失败病例的疗效。
方法：回顾性分析2009年1月至2012年12月收治的19例腰椎滑脱症翻修手术病例的临床资料，男12例，女7例；年龄36～68岁，平均51.5岁。其中滑脱节段复位丢失6例，内固定物松动或断裂5例，滑脱加重8例。临床症状有下腰部疼痛、单侧或双侧下肢疼痛麻木等。翻修手术采用后路三椎体椎弓根钉内固定，后路减压、复位，椎体间加后外侧植骨，对初次手术后发生椎弓根钉松动或断裂的椎体采用取出松动或断裂的螺钉，换用加粗或加长椎弓根螺钉进行再次置入，或者采用骨水泥灌注，置入椎弓根螺钉。应用X线正侧位片和伸屈动力位片评价椎间融合的效果，并采用JOA评分对疗效进行评定。
结果：翻修手术后均获随访，时间为10～30个月，平均18个月。X线显示所有翻修手术病例植骨融合良好，植骨融合时间5.5～7个月，滑脱椎体再次复位后矫正度无丢失，椎弓根螺钉无松动及断裂。JOA评分改善率为（78.06±3.90）%，以患者手术前及术后6个月随访时的JOA评分进行统计学分析，Ⅰ度滑脱3例，术前评分13.33±1.53，术后26.33±0.58；Ⅱ度滑脱7例，术前评分12.85±2.19，术后26.29±2.21；Ⅲ度滑脱9例，术前评分12.21±2.73，术后26.44±1.81.手术前后比较差异有统计学意义（P<0.01）.
结论：腰椎滑脱症初次手术失败原因主要与内固定物松动断裂和植骨不融合有关。翻修手术采用三椎体椎弓根钉内固定，可获得坚强内固定、充分减压、植骨融合，结合术后对患者功能锻炼的指导，可以取得满意的治疗效果。 |
| [关键词]:腰椎滑脱 治疗失败 翻修 脊柱融合 |
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| Three vertebral reduction and fixation for revision of lumbar spondylolisthesis |
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Abstract:
Objective: To analyze the surgical failture of lumbar spondylolisthesis and investigate the clinical effect of three vertebral reduction and fixation in revision of lumbar spondylolisthesis.
Methods: The clinical data of 19 patients underwent revision to lumbar spondylolisthesis was retrospectively analyzed between January 2009 and December 2012. There were 12 males and 7 females, aged from 36 to 68 years old with an average of 51.5 years. Reduction loss of olisthy segment had in 6 cases, internal fixation loosening or breakage had in 5 cases, slippage aggravating had in 8 cases. Clinical symptoms including lower back pain, unilateral or bilateral lower extremity pain and numbness, etc. Revision surgery was performed with three vertebral pedicle screw internal fixation and posterior decompression, reduction, and posterolateral bone graft between vertebral body. For the first time after surgery pedicle screw loosening or fracture of vertebral body, to switch thick or long pedicle screws implanted into again, or with bone cement perfusion and implanted with pedicle. The condition of intervertebral fusion and clinical effect were respectively assessed by X-ray films and JOA score.
Results: All patients were followed up from 10 to 30 months with an average of 18 months. X-ray showed all bone graft obtained fusion and fusion time was from 5.5 to 7 months after revision. No pedicle screws loosening and breakage were found and no reduction loss vertebral body. JOA score were statistically analyzed between preoperative and postoperative at 6 months, in 3 cases with degreeⅠ, the score respectively was 13.33±1.53 and 26.33±0.58;in 7 cases with degreeⅡ, the score respectively was 12.85±2.19 and 26.29±2.21; in 9 cases with degree Ⅲ, the score respectively was 12.21±2.73 and 26.44±1.81;there was statistical significance between preoperative and postoperative at 6 months, the improvement rate of JOA was (78.06±3.90)%.
Conclusion: For the patients with lumbar spondylolisthesis, the reason of primary surgical failure mainly concerned with internal fixation loosening and breakage, and bone graft no-fusion. Revision surgery using three vertebral pedicle screw internal fixation, can get rigid fixation, complete decompression, bone graft fusion, combined with the guidance of the postoperative functional exercise for patients, can obtain satisfactory therapeutic effects. |
| KEYWORDS:Lumbar spondylolisthesis Treatment failure Revision surgery Spinal fusion |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 李长胜.三椎体复位固定行腰椎滑脱翻修手术探讨[J].中国骨伤,2014,27(9):717~721 |
| 英文格式: | LI Chang-sheng.Three vertebral reduction and fixation for revision of lumbar spondylolisthesis[J].zhongguo gu shang / China J Orthop Trauma ,2014,27(9):717~721 |
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