腰椎滑脱伴邻近节段退变的诊疗分析.DOCVIP

临床医学论文-腰椎滑脱伴邻近节段退变的诊疗分析 ??????????????????? 作者：刘涛,李长青, 周跃,王建,初同伟,张东 【摘要】? ［目的］探讨腰椎滑脱伴邻近节段退变诊断、治疗效果及其临床意义。［方法］自2000年10月～2005年10月，对16例腰椎滑脱伴邻近节段退变患者行切开复位内固定术，采用Prolo腰椎功能评定评估腰椎术后功能，影像学评估椎体滑脱复位程度、椎间隙高度、固定节段前凸的恢复、融合器位置、植骨融合情况及内固定物有无松动等，对X线片结果可疑病例，追加CT检查。［结果］本组14病例获得随访，平均随访时间28个月（16～53个月）；术后3个月Prolo评分结果：7分3例，8分7例，9分2例，4分2例，优良率为85.7%；末次Prolo评分结果：7分4例，8分6例，9分4例，优良率为100%；术后6个月有8例达到骨融合标准，占66.7%，术后12个月有13例达到骨性融合标准，占92.9%；1例椎间融合可疑，患者没有临床症状和体征。术后1周复查X线片显示：完全复位10例，占71.4%，4例复位＞50%，术后12个月及末次随访复查没有出现复位丢失。术前、术后3个月及末次随访腰椎前凸角分别为26.64°、33.29°、32.36°；术前、术后6个月及末次随访固定节段前凸角分别为15.64°、28.29°、32.36°；椎间隙高度术前、术后分别为6.54 mm、9.62 mm,术前与术后相比有统计学意义（P＜0.05）。所有患者没有出现伤口感染、神经损伤等并发症，无内固定物断裂、松动；没有出现椎间融合器位置不良、塌陷、移位等并发症。［结论］腰椎滑脱伴邻近节段退变发病率和治疗具有自身的临床特点；采用双节段或三节段固定、融合近、中期临床效果优良，是一种有效、安全的方法。 【关键词】? 腰椎滑脱； 腰椎融合术； 邻近节段退变 ??? Abstract：［Objective］To investigate the diagnostic methods and clinical effects of the management of spondylolithesis with adjacent segment degeneration.［Method］Between October 2000 and October 2005, 16 consecutive patients (3 males and 13 females)?aging?42 to 76 years (mean 59.1 years) received instrumented lumbar interbody fusion procedure using traditional posterior approaches for spondylolithesis with adjacent segment degeneration. Lumbar functions were assessed using Prolo system. Preoperative and followup lateral lumbar radiographs were studied for reduction of spondylolithesis, disc heights, lumbar lordosis, fusion rates and complications. ［Result］Fourteen patients? were followed up, with an average duration of 28 (16–53) months. Clinical outcomes in terms of Prolo system was 7 points in 3 patients, 8 in 7 patients, 9 in 2 patients, and 4 in 2 patients at 3 months after operation with 85.7% being graded as good or excellent. Seven points in 4 patients, 8 in 6 patients, and 9 in 4 patients at last followup(graded as 100% good or excellent). Fusion rate was 66.7%( 8/14)at 6 months and 92.9% (13/14)at 12 months after operation. Ten patients(71.4%) fully recovered from spondylolithesis,4