摘要
目的比较两种脊柱融合术治疗腰椎管狭窄症伴轻度腰椎滑脱的临床疗效.方法将1998年4月至2003年4月收治的45例患者分为A、B两组.分别行椎管减压+SOCON复位+横突间植骨术(A组),在A组基础上加用椎间融合器(Cage)固定(B组).A组24例,平均54岁,其中退变型17例,峡部型7例.B组21例,平均53岁,其中退变型16例,峡部型5例.两组滑脱主要部位为L4-5和(或)L5～S1, 滑脱度为Ⅰ至Ⅱ度,术前均行脊髓造影或CTM检查,证实有侧隐窝狭窄和(或)中央椎管狭窄.结果随访时间1～6年,A组临床疗效满意率91.7 %(22/24);完全复位率为91.7 %(22/24).B组临床疗效满意率90.5 %(19/21);完全复位率为95.2 %(20/21).A组手术时间、术中出血、输血量、手术并发症情况优于B组,两组滑脱复位率及随访后最终临床疗效无显著差异,B组滑脱角及椎间盘指数恢复优于A组.结论彻底减压、后外侧融合加椎弓根内固定是首选手术方案,应强调Cage适应证.
Objective To compare and evaluate instrumented posterior fusion with instrumented circumferential lumbar fusion in the treatment of lumbar stenosis with low degree lumbar spondylolisthesis. Methods From April 1998 to April 2003, 45 patients who suffered from lumbar stenosis with low degree lumbar spondylolisthesis were divided into 2 groups (A and B) at random. The patients in group A (n=24,average age 54 years old) were performed decompressive laminectomy,intertransverse process arthrodesis with bone grafting and transpedicle instrumentation of solid connection(SOCON) system. The patients in group B (n=21,average age 53 years old) were performed the same procedure as group A except adding posterior lumbar interbody fusion (PROSPACE). The main levels of lumbar spondylolisthesis in 2 groups was L 4-5 or L 5-S 1. All cases were classified as degree 1 to degree 2. All patients in the two groups received preoperative myelography or CTM, and were diagnosed lateral recess stenosis and(or) central lumbar canal stenosis.Results All the patients were followed up from 12 to 72 months. In group A, the results showed that the preoperative clinical symptoms disappeared completely in 12 of 24 patients, pain relief was seen in 91.7%(22/24), anatomical reduction rate was 91.7%. No infection or neurologic complication occurred in this series. In group B, the results showed that the preoperative clinical symptoms disappeared completely in 13 of 21patients, pain relief was seen in 90.5% (19/21),anatomical reduction rate was 95.2%. Four cases of infection or neurologic complication occurred in this series. Two groups had no significant difference in follow-up clinical outcome and anatomical reduction rate. But group A had better intraoperative circumstances and postoperative outcome than group B, group B had better postoperative parameters in X-ray of angle of slipping and disc index than group A.Conclusions The best surgical treatment method of lumbar stenosis with low degree lumbar spondylolisthesis is complete intraop
出处
《中华外科杂志》
CAS
CSCD
北大核心
2005年第8期486-490,共5页
Chinese Journal of Surgery
