腰椎滑脱髂骨棒杠杆复位固定系统的研制和临床应用.DOCVIP

临床医学论文-腰椎滑脱髂骨棒杠杆复位固定系统的研制和临床应用 ?????????????? 作者：张国川，申勇，丁文元，孟宪国，张英泽 【摘要】? 　　目的 评价自主研发的髂骨棒杠杆复位固定系统(IBRFS)治疗腰椎滑脱的疗效。[方法]应用IBRFS 治疗18例腰椎滑脱病人，L5滑脱12例，L4滑脱6例，其中1例L5骶化。根据Meyerding滑移分度法：10例Ⅰ度，6例Ⅱ度，2例Ⅲ度。DS 9例，IS 8例，外伤性1例，进行手术前后的滑脱百分率、滑脱角、骶骨倾斜角和椎间隙高度的测量，并按复位效果、症状改善、椎间植骨融合进行疗效评价。[结果]临床治疗病例随访8～28个月，平均14.9个月。术前JOA评分范围-1～22，平均10.7;术后JOA评分范围13～29，平均26.9。总治愈率范围42.9%～98%，平均88.2%，没有出现神经并发症。X线摄片和CT两维重建提示成功融合15例，3例融合失败。滑脱率由20.80%降至5.01%，滑脱角由6.67°恢复到12°，骶骨倾斜角由32.2°升至43.3°，椎间隙高度与滑脱节段的上位椎间隙高度比值由0.78升至0.97。[结论]IBRFS治疗腰椎滑脱疗效切实可靠，复位及固定效果满意，手术操作简便。 【关键词】? 内固定 腰椎滑脱症 植骨融合 　　Abstract：[Objective]To introduce the composion and mechanism of Iliac Bars Lever Reduction and Fixation System (IBRFS),and to evaluate the clinical efficacy of IBRFS.[Method]IBRFS was made of stainless steel composing of pedicle screw,anglar lift，reduction rod,iliac bar and screw nut A,B,C.Eighteen volunteers offered their contribution for this study.There were 6 males and 12 females with mean age of 53 years (range from 43-66 years).The classification was DS 9,IS 8,trauma 1.The slip segments were L4 6,L5 12.The reductive operation was conducted by IBRFS.Clinical efficiency was evaluated by slip ratio,slip angle,sacral slope and the height of intervertebral space.[Result]Eighteen patients were followed up from 8 to 28 months (average 14.9 months).Preoperative JOA scores ranged from -1 to 22 (mean 10.7).Postoperative JOA scores ranged from 13 to 29 (mean26.9).The overall recovery rate ranged from 42.9% to 98% (mean 88.3%).There was no neurologic complication. Slip ratio was improved from 20.80% to 5.01%,slip angle from 6.67皌o 12?and sacral slope from 32.2?to 43.3?The height ratio of intervertebral space was increased from 0.78 to 0.97.[Conclusion]The reduction efficiency of IBRFS is reliable.The restoration of height of intervertebral space is improved.IBRFS is an effective internal fixation. 　　Key words：internal fixation; spondylolisthesis; reduction 　　腰椎滑脱是临床常见病、多发病。主要症状为下腰痛或下肢根性疼痛和间歇性跛行。在人群中发病率约为5%，需要手术者又占5%左右，数量相当大[