退变性腰椎不稳症的诊断与治疗

目的:探讨退变性腰椎不稳症的诊断与治疗,比较手术治疗与非手术治疗的效果。方法:103例腰椎不稳症患者被分成两组进行为期10年的调查,其中手术组49例,采用后路棘突椎板间“H”型植骨融合术治疗;保守治疗组54例。所有患者均分别于治疗前、治疗后1年、10年,由专人随访并予问卷调查及评分。结果:治疗后1年,手术组、保守治疗组评分由1郾65、1郾74提高至2郾88、2郾06;治疗后10年,手术组及保守治疗组评分分别提高至3郾61、2郾59,与术前相比均有明显提高。两组间评分亦有显著差异,其中中、青年组评分手术组显著高于保守治疗组(P<0郾001),而老年组间则无显著差异(P>0郾05)。结论:退变性腰椎不稳症的诊断应主要依靠临床表现及X线测量。手术治疗应考虑患者的临床症状、年龄、职业及X线测量等多种因素。对中、青年患者,腰椎融合术可以减轻症状,缩短病程,早日恢复工作,是较好选择;而对老年患者,保守治疗效果并不低于手术治疗效果。

Diagnosis and treatment of symptomatic degenerative lumbar spinal instability

Objective:To assess the diagnosis and treatment of the symptomatic degenerative lumbar spinal instability(SDLSI).Method:103patients with the SDLSI were divided into the surgical group and the contrast group,and being investigated for ten years.There were49cases operated with the posterior Htype graft vertebral fusion in the surgical group,and there were54cases treated with nonoperation in the contrast group.All patients were examinated and graded before treatment,1year and10years after treatment.Result:The results indicated that the score increased respectively from1.65and1.74to2.88and2.06in the surgical group and the contrast group one year after treatment,and the score increased respectively to3.61and2.59in the surgical group and the contrast group ten years after treatment.The scores in two groups were significant difference in the young and middle ages(P<0.001),and no difference in the old age(P>0.05).Conclusion:The diagnosis and treatment for the SDLSI mainly depend on the clinical manifestations and the Xray measure.The clinical symptom,age,occupation and Xray should be considered for those who need surgical fusion.To short the course of the lumbar spinal instability,the surgical fusion should be used in the young and the middle age.Nonoperative management is the better choice for the old age.