自体植骨椎间融合加椎弓根内固定治疗腰椎节段性不稳症

目的 探讨节段性腰椎不稳症的手术改进方法和疗效.方法 采用自体植骨(椎间扩孔结合自体椎板骨粒、棘突骨块植骨)椎间融合加椎弓根内固定治疗节段性下腰不稳或潜在不稳91例.结果 91例均获得随访,随访时间8～32个月,平均16个月.按照改良Macnab法疗效评定标准,优74例,良15例,可2例,差0例,优良率98%.X线片显示椎体间植骨融合良好,无高度及复位丢失.结论 椎弓根内固定可矫正滑移,恢复脊柱的生理弧度,达到即刻稳定,增加植骨的融合率,提高了融合率,节省了医疗费用.

Treatment of Segmental Lumbar Spine Instability with Autologous Bone Grafting Plus Vertebral Pedicle Internal Fixation

Objective To investigate the modified approaches and the curative effect for treatment of the segmental lumbar spine instability.Methods The autologous bone grafting(intervertebrae reaming plus autologous vertebral plate bone grain and spinal process bone block grafting)plus vertebral pedicle internal fixation were used to treat the segmental lumbar instability or the potential lumbar instability in 91 patients.Results The follow up period ranged from 8 to 32 months,16 months on average.The clinical curative effect was excellent in 74 patients,good in 15,and acceptable in 2.The excellent and good rate was 98%.X-ray films showed that bone grafting fusion was good between the vertebrae.There was no loss in vertebral height and reposition.Conclusion Vertebral pedicle internal fixation can correct vertebral slip,restore the spinal physiologic curve,achieve instantly stabilization,increase the fusion rate of bone implant,and elevate the operative effects.However,there is close relationship between different bone grafting approaches and the success of vertebral fusion.The autologous vertebral plate and spinal process bone grafting reduces the complications,increases the fusion rate,and saves the medical cost.