PLIG技术在治疗中老年多节段腰椎不稳中的临床应用

目的:评价应用PLIG技术治疗中老年腰椎多节段退行性变并腰椎不稳的疗效。方法:对248例中老年患者采用后路椎体间植骨技术(PLIG),即一期彻底切除椎间盘,选择性椎管减压、后路单侧斜入式椎间植骨及椎弓根钉棒系统固定,恢复节段间的正常序列,使腰椎即刻稳定。结果:随访6个月~5年,优158例,良81例,可7例,差2例,优良率96.37%。术后3、6、8、12个月摄X线片显示复位稳定,椎间植骨良好,8个月后均获得骨性融合,6例由于骨质疏松出现椎间隙高度部分丢失,5例出现骨吸收现象,10例异体骨融合期延长,2例出现相邻间隙退行性变。结论:该技术治疗中老年多节段腰椎不稳,可彻底清除椎间盘组织,解除神经卡压,矫正畸形,提供稳定的生物力学环境,促进椎体间植骨融合,保存正常的功能。

Clinical application of posterior lumbar interbody graft technique in the treatment of multisegmental lumbar vertebral instability in middle aged and elderly

Objective:To evaluate the therapeutic efficacy of posterior lumbar interbody graft(PLIG) technique in the treatment of multisegmental lumbar vertebral degeneration and instability in middle aged and elderly.Methods: The PLIG technique was used to treat multisegmental lumbar vertebral degeneration and instability in 248 middle aged and elderly patients.The lumbar disc was completely removed,selective decompression of the spinal canal was performed,unilateral and inclined intervertebral bone graft was implanted and fixed with pedicle of vertebral arch screw-rods system by posterior approach,the normal intersegmental sequence was restored,and the stabled lumbar spine was repaired.Results:The follow-up time was from 6 to 66 months(average,51 months).The clinical effect was excellent in 158 patients,good in 81 patients,fair in 7 patients,and poor in 2 patients.The excellent and good therapeutic result was observed in 96.37% patients.The X-ray photograph taken 3,6,8,12 months after surgery showed that the lumbar spine and the graft bone was stable,bone union was achieved in all patients after 8 months.The intervertebral height lost partially in 6 patients because of osteoporosis.Bone resorption occurred in 5 patients,delayed union in 10 patients,and adjacent intervertebral disc degeneration in 2 patients.Conclusion:The PLIG technique can completely remove the lumbar disc in the treatment of multisegmental lumbar vertebral degeneration and instability in middle aged and elderly patients,decompress the spinal cord,and correct spine malformation.This technique can provide stable biomechanics environment,accelerate lumbar interbody fusion and reserve the normal function.