腰椎内固定术后顽固下腰痛原因分析.docVIP

. . 精品 精品 . 精品 腰椎内固定术后顽固下腰痛原因分析 袁建军1 阚世廉2 贾宇涛3 刘洋1 田融1 (1 天津医科大学研究生院 天津市人民医院 300070，2天津医院300211，3天津市人民医院300121) 作者简介：袁建军（1973-），男，天津人，副主任医师，博士在读，研究方向：脊柱外科，（电话）022（电子信箱） dr.yuanjianjun@163.com 摘要 目的：分析腰椎柔韧性及关节突关节退变程度对腰椎内固定术后下腰痛缓解率的影响。方法：随访100例行腰4,5单节段内固定术患者，术前测量前屈、后伸位腰椎前凸角度的变化作为腰椎柔韧性指标，测量腰3,4关节突关节角，并进行退变程度分级，术前和术后1年对病人进行Oswestry评分，并计算改善率。分析腰椎柔韧性及关节突关节退变对术后下腰痛改善率的影响。结果：腰椎柔韧性与手术后症状改善率呈正相关。关节突关节退变严重组术后症状改善率差，关节突关节角不对称组术后改善率较差。结论：腰椎柔韧性、关节突关节角对称性和关节突关节退变程度是影响腰椎内固定术后下腰痛改善率的重要因素，可为判断临床预后提供参考。 关键词：腰椎 内固定术 柔韧性 关节突关节 改善率 The analysis of the causes of obstinate low back pian after lumbar internal fixation. YUAN Jian-jun,KAN Shi-lian,JIA Yu-tao(Graduate School of Tianjin Medical University.Dept of Spinal Surgery, People’s Hospital of Tianjin,Tianjin 300121,China) Abstract objective: to investigate the effection of the lumbar flexibility, lumbar facet joint angle, facet joint degeneration on improvement rate of low back pain after lumbar internal fixation. method: 100 cases which undergone lumbar internal fixation of L4,L5 were followed up, facet joint angle of L3,4 was measured, degeneration of facet joint was graded, lumbar lordosis angle at extension and flexion position was measured aspectely, Oswestry score was obtained before and 1 year after operation. results: . . 精品 精品 . 精品 Lumbar flexibility is positively correlated with the improvement rate of low back pain,the patients with severe degeneration of the facet joint and asymmetry facet joint angle have a bad improvement rate. Conclusion: lumbar flexibility、lumbar facet joint degeneration and facet joint symmetry are important factors which influence the outcome of lumbar internal fixation. Key words: lumbar internal fixation flexibility facet joint improvement rate 腰椎退行性疾病是脊柱外科常见疾病，腰腿痛是其主要症状，目前临床公认的治疗原则是充分的神经减压和内固定植骨融合。术后影像学虽然显示获得了彻底的神经减压和良好的融合，但有些患者腰腿痛症状尤其是下腰痛症状恢复并不理想。本研究随访我院手术治疗的腰椎退行性疾病患者100例，观察分析腰椎柔韧性和手术相邻节段关节突关节退变程度对下腰痛的影响，以期对临床治疗提供帮助。 1 材料与方法 1.1 一般资料 随访观察2008年1月至2010年1月在我科接受腰椎减压内