开窗减压椎间植骨融合内固定治疗退变性腰椎不稳

目的]探讨开窗减压、椎间植骨融合(PLIF)内固定治疗老年退变性腰椎不稳.方法]81例临床病人,男38例,女43例;年龄47～71岁,平均62岁;病变部位:L2、3间隙2例,L3、4间隙63例,L4、5间隙33例,L5S1间隙5例;2节段椎间融合21例,3节段椎间融合15例,4节段椎间融合2例;伴椎体Ⅰ度滑脱26例,伴有>15°侧凸的4例.术前常规摄腰椎正侧位、双斜位、腰椎过伸过屈动力位片、CT及MRI,了解椎管狭窄及椎体不稳程度;经腰椎后路行椎弓根钉棒系统内固定、开窗椎管减压、自体骨及Cage椎间植骨融合手术治疗,术中行撑开、提拉,将减压的自体椎板骨质修整,颗粒状碎骨填充于Cage,块状较大的骨块植入椎间隙,术后1周带腰围或佩戴支具下床活动.结果]本组随访时间2～4年,术后均行X线片复查,随访X线片显示椎间植骨融合良好,椎体复位无丢失,螺钉无折断和松动.手术前、后椎体滑移距离和ODI指数两项参数的配对比较差异具有显著性.结论]椎弓根钉棒系统内固定、开窗椎管彻底减压、自体骨混合Cage椎间植骨融合是治疗退变性腰椎不稳的一种有效手术方法.

Surgical treatment of degenerative lumbar instability with fenestration decompression,PLIF and internal fixation

Objective]To discuss the methods of fenestration decompression, PLIF and internal fixation for degenerative lumbar instability. Method]There were 81 patients with degenerative lumbar disease. They were 38 males and 43 females,aged from 47-71 years with an average of 62 years. There were 2 lesions L_(2/3), ,63 between L_(3/4) ,33 between L_(3/4) and 5 between L_5/S_1. Twenty-one lesions were fused in two segments,15 in three segments and 2 in four segments. All of the cases had X-ray in routine and oblique view.CT and MRI preoperatively. They were treated with fenestration decompression,intervertebral bone grafting and internal fixation for degenerative lumbar instability with pedicle screws and interbody fusion with block of autogenous vertebra] plate bone or cages filled with patches of bone. Most of patients began out-of-bed activity with waistline or orthosis at 1 week after operation. Result]The follow-up were 2 to 4 years. The radiographic views showed good fusion.no shift again and no screw breaking and lossening. There was significant difference between pre-and postoperation spondylolishesis distance. So was Oswestry index. Conclusion]It is effective to have feneslration,internal fixation with pedicle screws and fusion with block of autogenous vertebral plate bone or cages filled with patches of bone for degenerative lumbar instability.