经皮椎弓根螺钉内固定联合骶前间隙轴向椎间融合治疗L5椎体滑脱症

Percutaneous pedicle screw reduction and axial lumbar interbody fusion for lumbosacral spondylolisthesis

中文关键词:  轴向椎间融合术  经皮椎弓根钉  腰椎滑脱症

英文关键词:Axial lumbar interbody fusion  Percutaneous pedicle screw  Lumbosacral spondylolisthesis

中文摘要:

  【摘要】 目的：探讨采用经皮椎弓根钉内固定联合骶前间隙轴向椎间融合术（axial lumbar interbody fusion，AxiaLIF）治疗L5椎体滑脱症的临床效果。方法：2010年6月~2013年3月我院收治17例L5椎体滑脱症患者，均采用经皮椎弓根钉内固定联合骶前间隙轴向椎间融合术治疗。其中男8例，女9例；年龄33～58岁，平均43.7岁。退变性腰椎滑脱5例，峡部裂性腰椎滑脱11例，创伤性腰椎滑脱1例；17例均为Ⅱ度以内L5椎体滑脱。观察手术时间、术中出血量及并发症发生情况，影像学观察Taillard指数、滑脱角、椎间隙高度及植骨融合情况，以视觉疼痛模拟评分（VAS）评估临床效果。结果：17例手术时间110～190min，平均140min；术中出血60～150ml，平均70ml；全部病例随访9～27个月，平均14.5个月。Taillard指数由术前0.1632±0.0325改善至术后1周0.0716±0.007，末次随访为0.0732±0.008。滑脱角由术前5.32°±1.37°改善至术后1周2.14°±0.60°，末次随访为2.33°±0.50°。椎间隙高度由术前平均（4.78±1.43）mm改善至术后1周（9.72±1.69）mm，末次随访为（9.68±1.18）mm。Taillard指数、滑脱角及椎间隙高度术前与术后1周时比较差异均有统计学意义（P<0．05），术后1周与末次随访比较差异均无统计学意义（P>0．05）。所有病例术后6个月薄层螺旋CT扫描三维重建可见完全的骨小梁连接，达到骨性融合。术前及末次随访腰痛VAS评分分别为7.34±1.56分、0.73±0.68分，末次随访时较术前明显改善（P<0．05）。术后出现单侧的下肢疼痛2例，感染2例，经对症处理后痊愈。余无内固定等相关并发症发生。结论：经皮椎弓根钉内固定联合骶前间隙轴向椎间融合术对腰椎结构破坏小，出血少，近期手术效果好，是一种治疗Ⅱ度以内L5椎体滑脱症的有效组合微创方法。

英文摘要:

  【Abstract】 Objectives: To evaluate the clinical outcomes of percutaneous pedicle screws plus axial lumbar interbody fusion(AxiaLIF) for lumbosacral spondylolisthesis. Methods: From June 2010 to March 2013, 17 cases suffering from lumbar spondylolisthesis undergoing percutaneous pedicle screws plus axial lumbar interbody fusion were reviewed retrospectively. There were 8 males and 9 females with the age at time of surgery ranging from 33 to 58 years(mean, 43.7years). There were 5 degenerative spondylolisthesis, 11 spondylolysis spondylolisthesis and 1 traumatic lumbar spondylolisthesis. All cases were less than degree Ⅱ spondylolisthesis. The operation time，blood loss and complications were recorded．Radiography assessment included the Taillard index, slipping angle，intervertebral disc height and fusion rate. Visual analogue scale(VAS) was used for clinical assessment． Results: The average operation time was 140(range, 110-190) minutes and average intraoperative blood loss was 70(range, 60-150)ml． All case were followed up for 9 to 27 mouths(average, 14.5 mouths). Taillard index improved from 0.1632±0.0325 to 0.0716±0.007 at 1 week postoperatively and 0.0732±0.008 at final follow-up． Slipping angle decreased from 5.32°±1.37° to 2.14°±0.60° at 1 week postoperatively and 2.33°±0.50° at final follow-up. The intervertebral disc height increased from 4.78±1.43mm to 9.72±1.69mm at 1 week postoperatively and 9.68±1.18mm at final follow-up. There were statistical differences with respect to the Taillard index, slipping angle and intervertebral disc height between preoperation and 1 week postoperatively(P<0．05), while no statistical difference between 1 week postoperatively and final follow-up(P>0．05). Solid bony fusion was achieved under thin-section helical computed tomography(CT) scanning at 6 months follow-up. The VAS score of low back pain at preoperation and final follow-up was 7.34±1.56 and 0.73±0.68 respectively, During follow-up, leg pain and wound infection was noted in 2 cases respectively, cured after symptomatic treatment. Conclusions: Percutaneous pedicle screw reduction and axial lumbar interbody fusion is effective for lumbosacral spondylolisthesis due to its less invasive to the posterior structure, less intraoperative blood loss．