单枚cage单侧椎弓根螺钉内固定术治疗退行性腰椎不稳

目的:探讨后路单枚cage单侧椎弓根钉内固定术治疗退行性腰椎不稳的临床效果.方法:采用后路椎弓根钉及椎间融合器治疗需行内固定融合手术的退行性腰椎不稳患者(均有腰痛及一侧下肢疼痛)51例,男32例,女19例,年龄41～72岁.单节段47例,其中L3/4 1例,L4/5 25例,L5/S1 21例;双节段4例,其中L3/4和L4/5 1例,L4/5和L5/S1 3例.手术方法均采用单侧显露症状侧椎板及关节突,单侧置入椎弓根钉,经椎间孔入路(TLIF手术)切除椎间盘及软骨终板,植骨后放入单枚cage.根据日本JOA评分法评估术后疗效,结果:手术时间单节段平均100min,双节段平均150min.术中出血90～430ml,其中单节段平均140ml,双节段24Oml.术前JOA评分平均11分,术后1年时平均25分.优38例(74.51%),良10例(19.61%),可2例(3.92%),差1例(1.96%),优良率为94.12%.经1～2.5年随访,所有患者椎体间融合良好,未发现断钉及cage移位.结论:单侧椎弓根钉及cage内固定术,手术方法简单,出血少、手术时间短,对脊柱结构破坏少,是治疗退行性腰椎不稳可供选择的较好方法.

Clinical research of single cage plus unilateral pedicle screw placement for the treatment of lumbar degenerative instability

Objective:To explore the clinical efficacy of single cage plus unilateral pedicle screw placement for the treatment of lumbar degenerative instability .Method: 51 cases with lumbar degenerative instability patients underwent single cage plus unilateral pedicle screw instrumentation and fusion,of them,there were 32 males and 19 females, with age ranging from 41 to 72 years old.Most cases complained of low back pain combined with radiological pain in lower limbs.47 cases had single segment involved (1 case in L3/4,25 cases in L4/5,21 cases in L5/S1),4 cases had two segments involved (1 case in L3/4 and L4/5,3 cases in L4/5 and L5/S1).A11 cases experienced unilateral laminectomy and transforamenal lumbar interbody fusion,the clinical outcome was assessed by JOA score system.Result:The blood loss was 90-430ml (140ml for single segment,240ml for double segements).The surgical time was l00min for single segment involement and 150min for double segments.Incision infection has not found.The average JOA scores at preoperation and 1 year follow-up was 11 and 25 respectively.38 cases were rated as excellent (74.51%), 10 cases as good (19.61%),2 cases as fair(3.92%) and 1 case as poor(1.96%) with the total excellent and good rate of 94.12%.Postoper-ative X-ray showed no evidence of instrument failure.Conclusion:Single cage plus unilateral pedicle screw placement for lumbar degenerative instability is reliable and less interference with lumbar stability.