- 1、本文档共13页,可阅读全部内容。
- 2、原创力文档(book118)网站文档一经付费(服务费),不意味着购买了该文档的版权,仅供个人/单位学习、研究之用,不得用于商业用途,未经授权,严禁复制、发行、汇编、翻译或者网络传播等,侵权必究。
- 3、本站所有内容均由合作方或网友上传,本站不对文档的完整性、权威性及其观点立场正确性做任何保证或承诺!文档内容仅供研究参考,付费前请自行鉴别。如您付费,意味着您自己接受本站规则且自行承担风险,本站不退款、不进行额外附加服务;查看《如何避免下载的几个坑》。如果您已付费下载过本站文档,您可以点击 这里二次下载。
- 4、如文档侵犯商业秘密、侵犯著作权、侵犯人身权等,请点击“版权申诉”(推荐),也可以打举报电话:400-050-0827(电话支持时间:9:00-18:30)。
- 5、该文档为VIP文档,如果想要下载,成为VIP会员后,下载免费。
- 6、成为VIP后,下载本文档将扣除1次下载权益。下载后,不支持退款、换文档。如有疑问请联系我们。
- 7、成为VIP后,您将拥有八大权益,权益包括:VIP文档下载权益、阅读免打扰、文档格式转换、高级专利检索、专属身份标志、高级客服、多端互通、版权登记。
- 8、VIP文档为合作方或网友上传,每下载1次, 网站将根据用户上传文档的质量评分、类型等,对文档贡献者给予高额补贴、流量扶持。如果你也想贡献VIP文档。上传文档
查看更多
复杂性腰椎管狭窄症外科治疗
复杂性腰椎管狭窄症外科治疗
作者:郝定均,贺宝荣,郭 华,宋宗让,吴起宁,刘团江
【摘要】 [目的]探讨复杂性腰椎管狭窄症的手术方法。[方法]回顾性分析1997年1月~2001年1月采用后路减压、植骨融合、椎弓根螺钉系统内固定治疗复杂性腰椎管狭窄症176例,男98例,女78例;平均年龄58.5岁。病史2~31年。既往腰椎有1次手术史者35例,2次或2次以上者19例,合并退变性Ⅰ度以上滑脱40例,合并腰椎侧凸,Cobbs角大于20° 42例,术后伴有腰椎不稳21例,术后交界处椎管狭窄19例。术中对一个或两个节段者切除椎间盘,处理相邻椎板,行椎间植骨融合,部分保留小关节突者同时行小关节融合;两个节段以上者对不需要切除椎间盘或者切除小关节突小于1/2者行小关节突加横突间融合,切除椎间盘者行椎间融合;合并腰椎侧凸者对狭窄部位先行后方减压,植入椎弓根螺钉,安装连接棒,应用旋棒,结合压缩、撑开技术矫正侧凸,对椎间盘突出较重的间隙行椎间融合加小关节突融合,其余节段行后外侧融合。[结果]手术时间80~250 min,术中出血450~1 600 ml,无围手术期死亡。术后平均随访5.6年,JOA评定以改善率表示,椎间融合优良率87.4%,多间隙优良率为86.1%,合并腰椎侧凸者优良率为89.8%。合并腰椎侧凸Cobbs角平均6.7°,矫正率73.8%。腰椎后外侧融合率92%(60/65),椎间融合组为97.9%(139/142)。[结论]复杂性腰椎管狭窄症手术难度大,风险高。后路椎管减压、植骨融合、经椎弓根螺钉系统内固定是一种较好的治疗方法。
【关键词】 腰椎管狭窄; 脊柱滑脱; 脊柱侧凸; 手术治疗
Abstract: [Objective]To investigate the methods of surgical treatment of complicated lumbar spinal stenosis. [Methods]Totally 176 patients who were diagnosed as having complicated lumbar spinal stenosis, operated by back decompression, fused by bone graft and internal fixed by pedicle screws from January 1997 to January 2001 were retrospectively analyzed. Ninety-eight were males and 78 were females,with an average age of 58.5 years. Patient history was from 2 to 31 years. Thirty-five patients had a previous surgery on lumbar vertebrae,and 19 patients had two or more. Forty patients were complicated with one degree degenerated olisthe, 42 were complicated with lumbar scoliosis and Cobb?s angle more than 20°,21 had lumbar unsteadiness after surgery,19 patients had spinal stenosis in juncture after surgery.One ore two segments intervertebral discs were removed and vertebral plate were closed together, fused by bone graft and fused articular process.To the patients with more than two segments affection, processus articularis and processus transverses were fused to the patients need not remove intervertebral disk or remove less than half of processus articularis and interbody vertebral were fused to the patient need remove intervertebral disk.Patients with scoliolosis were de
文档评论(0)