后路减压融合内固定术治疗退变性腰椎椎管狭窄合并节段性腰椎不稳的临床疗效

目的：观察后路腰椎椎管减压、椎弓根螺钉内固定并椎体间植骨融合术，治疗退变性腰椎椎管狭窄合并节段性腰椎不稳定患者的临床疗效。方法2006年1月～2011年12月收治的82例退变性腰椎椎管狭窄合并节段性腰椎不稳的患者，行后路减压融合内固定术治疗。采用Oswestry功能障碍指数（Oswestry disability index， ODI），疼痛视觉模拟量表（visual analogue scale， VAS）和日本骨科学会（Japanese Orthopaedic Association，JOA）评分评估临床疗效。同时行影像学检查，测量椎间隙高度，用Bridwell方法评价腰椎融合情况。结果平均随访48个月，术后腰痛VAS评分、腿痛VAS评分、JOA评分、ODI、椎间隙高度均较术前明显改善，差异有统计学意义（P＜0．01）。末次随访时，根据Bridwell腰椎融合评价标准，Ⅰ级和Ⅱ级为80例（97．5％）。末次随访时，X线片、MRI检查发现4例螺钉松动断裂但已骨性融合（4％），2例植骨未融合，椎间隙高度降低（2％）。疗效评定优24例，良46例，可8例，差5例，优良率为85．4％。结论减压融合固定治疗退变性腰椎椎管狭窄症合并节段性腰椎不稳远期疗效肯定，但应把恢复该节段的稳定作为重点。

Clinical efficacy of posterior decompression and fusion and internal fixation for treatment of degenerative lumbar spinal stenosis with lumbar segmental instability

Objective To observe the Clinical efficacy of posterior decompression and fusion and internal fixation for treat -ment of degenerative lumbar spinal stenosis with lumbar segmental instability .Methods From 2006 January to 2011 Decem-ber, 82 cases of degenerative lumbar spinal stenosis with lumbar segmental instability were treated with posterior decompres -sion, fusion and internal fixation.Oswestry disability index （ODI）, visual analogue scale （VAS） and Japanese Orthopaedic Association（JOA ） scores were used to evaluate the clinical efficacy .Intervertebral height were observed on roentgenographs , and Bridwell method were used to evaluate lumbar fusion .Results The average follow-up was 48 months, VAS score of low back pain and leg pain , JOA scores, ODI and height of intervertebral space was significant improved compared with the preop -erative （P〈0.01）.At final follow-up, according to the Bridwell of lumbar fusion evaluation standard , grade I and grade Ⅱin 80 cases （97.5%）.At final follow-up, roentgenograph and MRI found 4 cases of screw loosening or fracture , but were bony fusion （4%）, 2 cases were not bone fusion, intervertebral height decrease （2%）.The results were excellent in 24 cases, good in 46 cases, 8 cases, poor in 5 cases, the excellent and good rate was 85.4%.Conclusion posterior decom-pression and fusion and internal fixation for treatment of degenerative lumbar spinal stenosis with lumbar segmental instability has a good long-term efficacy of decompression , but should restore the segmental stability as the key .