椎弓根内固定在下腰椎失稳伴椎管狭窄手术中的应用

目的：探讨下腰椎失稳伴椎管狭窄的手术要点及椎弓根内固定在手术中的作用和意义。方法：总结2001年5月～2004年6月采用后路椎管减压、椎弓根内固定及椎间关节融合、横突间植骨治疗的32例下腰椎失稳伴椎管狭窄病例的临床资料。结果：32例随访6个月-40个月，平均19．5个月，术后跛行改善者32例（100％），下肢肌力障碍恢复22例（68．7％），肌萎缩14例均有所恢复；28例感觉障碍者，完全恢复18例（64．3％），部分恢复6例（21．4％）。无明显恢复2例（7．1％）。结论：下腰椎失稳伴椎管狭窄可分别表现为结构性和动力性腰椎滑脱，椎弓根内固定对病人可起到使滑脱椎体复位、相邻椎体间稳定及椎间融合的作用，并可使摘除椎间盘后的相关间隙高度得到维持。充分解除神经受压症状。

THE APPLICATION OF TRANS- PEDICLE INTERNAL FIXATION IN THE UNSTABLE LOW LUMBAR VERTEBRA WITH LUMBAR SPINAL STENOSIS

Objective:To discuss the key point of lumber spinal cannal stenosis surgery and the principle and significance of trans-pedicle internal fixation in the unstable low lumbar vertebra with lumbar spinal stenosis.Method:32 the unstable low lum- bar vertebra with lumbar spinal stenosis cases underwent extensive vertebral lamina decompression,trans-vertebral pedicle internal fixation,inter-vertebral fusion and inter-transverse process bone graft.Results:All 32 cases were followed-up for 6-40 months,averaged 19.5 months,with limping ameliorated in 32 cases (100%) and lower extremities myodynamia recovered in 22 cases (68.7%).All of the 14 myoattrophic patients gained some recovery.Among the 28 sensory disability cases,18 cases (64.3%) fully recovered,6 cases (21.4%) partially recovered,2 cases (7.1%) barely showed any recovery.Conclusion: The unstable low lumbar vertebra with lumbar spinal stenosis content lumber structural and dynamic slippage.Trans-pedicle inter- nal fixation can reduction,verttebra stabilization and fusion for this patients,it can maintain the intter-vertebra height following the lumber disk removal and lower the possibility of degenerative tissue protruding.