椎弓根螺钉内固定与植骨术治疗高龄患者腰椎不稳定

目的：观察腰椎管减压、横突间或椎体间植骨脊柱融合和椎弓根螺钉内固定手术治疗高龄退行性病变腰椎不稳定患者的效果。方法：1991年3月－1999年9月，对51例经长期正规保守治疗无效的腰椎退行性不稳定70岁以上高龄患者，入院行腰椎管减压、横突间或椎体间植骨和椎弓根螺钉内固定手术，观察手术后临床症状改善和X线片显示的植骨融合程度。结果：术后平均随访3年11个月（2－8.5年），所有患者的症有不同程度的改善；临床植骨融合率90.2％；临床疗效：优35例，良18例，可8例，优良率为86.9％。结论：腰椎管减压、横突间或椎体间植骨和椎弓根螺钉内固定治疗腰椎退行性不稳定的疗效肯定，同样适合于高龄骨患者的手术治疗。

The Treatment of Lumbar Spinal Instability of Elder Patients with Pedicle Screw Fixation and Posterior Lumbar Fusion

Objective: To evaluate the efficacy of decompress laminectomy, pedicle screw fixation and posterior lumbar fusion in the treatment of degenerative lumbar spinal instability of elder patients. Methods: From March 1991 to September 1999, sixty-one patients, were diagnosed as degenerative lumbar spinal instability by the imaging studies of plain radiographs, computerized tomography and MRI. There were 32 males and 29 females, aged from 70-81years old, with an average of 73.2 years. The decompression of the spine canal stenosis was achieved by lumbar laminectomy, the concomitant intertransverse process arthrodesis and posterior lumbar interbody fusion were performed by means of bone chip grafting from the iliac crest, and pedicle screw system was installed by pedicle screw fixation devices. Results:The patients were followed up from 2 to 8.5 years, with an average of 3years and 11 months. The results showed that the pre-operative clinical symptoms disappeared differently in all of the patients. Solid fusion was achieved in 90.2%of the patients. 86.9%of the patients obtained successful clinical outcome. Conclusions:As an effective way of treatment in degenerative lumbar spinal instability, decompress laminectomy, pedicle screw fixation and posterior lumbar fusion can also be used in elder (over 70 years) patients.