改良后路椎体间融合联合骨水泥强化术治疗老年腰椎滑脱症的效果观察

Outcome of modified posterior lumbar interbody fusion and PMMA augmented pedicle screw instrumentation for lumbar spondylolisis in aged patients

中文关键词:  腰椎滑脱症  脊柱融合术  椎体强化术  老年  效果

英文关键词:Lumbar spondylolysis  Spinal fusion  Vertebral augmentation  Aged patients  Outcome

中文摘要:

  【摘要】 目的：评估改良后路椎体间融合联合骨水泥强化术治疗老年腰椎滑脱症的效果。方法：2006年3月~2010年10月采用改良后路椎体间融合联合骨水泥强化术治疗老年腰椎滑脱症20例，男9例，女11例，年龄60～79岁，平均63.6岁。退变性滑脱9例，峡部裂性滑脱11例；Ⅰ度滑脱4例，Ⅱ度滑脱12例，Ⅲ度滑脱4例。单节段滑脱14例，其中L3 3例、L4 2例、L5 9例；双节段滑脱6例，其中L4、L5滑脱4例，L3、L4滑脱2例。均行全椎板切除减压、椎间隙撑开复位融合、椎弓根钉棒内固定联合骨水泥强化椎弓根螺钉钉道手术。术前、术后3个月和末次随访时测量椎间隙高度、椎间孔高度、滑脱距离、滑脱率及滑脱角，并进行Oswestry功能障碍指数（ODI）评分，随访椎间融合情况。结果：术中出现骨水泥渗漏3例，但术中及术后无任何不适。术中硬脊膜撕裂2例，1例裂口较小，术中未予处理；1例裂口较长，术中缝合后以明胶海绵覆盖，术毕紧密缝合腰背筋膜及皮肤切口，术后采取头低脚高位、脱水等治疗，未见脑脊液漏出。术后出现神经根刺激症状3例，予以脱水、营养神经治疗，均症状消失。术后滑脱均有不同程度复位，腰椎生理曲度恢复。术后3个月椎间隙高度、椎间孔高度、滑脱距离、滑脱率、滑脱角及OD1评分与术前比较均有统计学差异（P＜0.05）。随访17～49个月，平均30.5个月，末次随访上述各指标与术前比较均有统计学差异（P＜0.05），与术后3个月比较均无统计学差异（P＞0.05）。按照ODI评分疗效判定，术后3个月及末次随访时的优良率分别为89.2％及91.3％。随访期间矫正程度无明显丢失，钉道无松动。融合成功18例，融合率90％。结论：采用改良后路椎体间融合联合骨水泥强化术治疗老年腰椎滑脱症安全有效。

英文摘要:

  【Abstract】 Objectives: To evaluate the outcome of modified posterior lumbar interbody fusion(PLIF) and Polymethylmethacrylate(PMMA) augmented pedicle screw instrumentation for lumbar spondylolisis in aged patients. Methods: The clinical outcomes and radiological data were assessed retrospectively in a series of 20 aged patients with lumbar spondylolisis who undergoing surgical treatment from March 2006 to October 2010． The study group consisted of 9 males and 11 females aged 60-79 years（averaging 63.6 years）. 9 cases presented with degenerative spondylolisis, 11 cases with isthmic spondylolisthesis. 4 cases had Ⅰ degree slipping, 12 cases had Ⅱ degree slipping, 4 cases had Ⅲ degree slipping. 14 cases had single-level involved with 3 cases in L3, 2 cases in L4, 9 cases in L5. 6 cases had double-level involved with 4 cases in L4 and L5, 2 cases in L3 and L4. After decompression, the PMMA augmented pedicle screw instrumentation was performed followed by interbody morselized bone graft. The clinical outcomes were determined by Oswestry disabihty index(ODI) and the radiographic evaluation including disc height and foramen height, slipping displacement, slipping degree, and the slipping angle at 3 months after surgery and final follow-up was reviewed. The outcomes of interbody fusion were followed up. Results: Asymptomatic bone cement leakage out of vertebral body was observed in 3 cases. Dural sac laceration occured in 2 cases, with 1 dural sac fissure needing no repair and 1 long laceration being sutured properly． All 2 patients had no cerebrospinal fluid leakage after intervention． 3 cases were complicated with neurological deficit, after the dehydration and nerve nutrient medicine were administered, all neurological deficit recovered completely. All patients had normal sagital plane alignment. The radiological data and ODI between preoperation and 3 months after operation, between preoperation and final follow-up all showed significant difference(P<0.05) respectively, while those between 3 months after operation and fianl follow-up showed no significant difference(P＞0.05). Based on the outcomes of ODI, the rate of excellent-and-good was 89.2％ and 91.3％ for 3 months and final follow-up. No loss of reduction was noted during the mean follow-up of 30.5 months(range, 17-49months). 18 cases were noted bony fusion with the fusion rate of 90％. Conclusions: The modified PLIF and PMMA augmented pedicle screw instrumentation is safe and reliable for lumbar spondylolisis in aged patients.