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学科主题骨科学
重度发育不良性腰椎滑脱的手术治疗
其他题名The treatment of severe lumbar dysplastic spondylolisthesis
郭昭庆; 陈仲强; 齐强; 李危石; 曾岩; 孙垂国
关键词脊柱滑脱 腰椎 发育不良性 手术治疗 Spondylolysis Lumbar Dysplastic Surgical Treatment
刊名中华外科杂志
2014
DOI10.3760/cma.j.issn.0529-5815.2014.11.014
52期:11页:845-850
收录类别中国科技核心期刊 ; 中文核心期刊 ; CSCD
文章类型Journal Article
摘要目的 探讨重度发育不良性腰椎滑脱症行后路减压、椎弓根复位及固定、椎体间融合术的疗效.方法 对2007年3月至2012年2月收治的12例重度发育不良性滑脱症患者进行回顾性研究.本组共12例,女性10例,男性2例,年龄9~17岁,平均10.7岁.所有病例均为L5滑脱,均经正规保守治疗无效而行手术治疗.患者均行后路减压、椎弓根螺钉复位内固定术,其中11例为单纯后路手术,1例为前后联合入路L5椎体切除术.8例为L4 ~S1固定,4例为L5~S1固定.滑脱节段均行椎体间植骨融合术.以视觉模拟量表(VAS)、Oswestry功能障碍指数及日本骨科协会(JOA)评分评定临床疗效.通过影像学观察术前及术后滑脱程度、滑脱角、腰椎前凸角、脊柱矢状面平衡等的变化.结果 随访时间6~64个月,平均32个月.12例中的5例术后出现神经损伤,多为单侧或双侧L5神经根损伤.随访时4例神经损伤完全恢复正常,1例仍残留一侧腓骨长短肌力弱,但对正常生活无影响.VAS、Oswestry功能障碍指数及JOA评分均有明显改善.所有病例的滑脱程度均减少Ⅱ度或Ⅱ度以上,滑脱节段均已骨性融合,复位未见明显丢失,未见内固定松动及断裂.滑脱角度由术前平均35.6°减少至术后9.8°.腰椎前凸角及脊柱矢状面平衡均有明显改善.结论 发育不良性重度腰椎滑脱行单纯后路减压、复位、内固定可获得满意的临床疗效.手术复位可矫正腰骶段的后突畸形,恢复腰椎的正常生理前突,改善外观及全脊柱的力线,同时可增加滑脱间隙的椎体间接触面,提高融合率.由于复位增加了对L5神经根的牵张,神经损伤的发生率较高,但大多可自行恢复. Objective To summarize the clinical characteristics of severe lumbar dysplastic spondylolisthesis,and to investigate the effectiveness of the posterior surgery including decompression,partial reduction with instrumentations and interbody fusion.Methods Twelve patients of severe lumbar dysplastic spondylolisthesis treated between March 2007 and February 2012 were studied retrospectively.Twelve patients include 10 female and 2 male patients with an average age of 10.7 years (9-17 years).All of their spondylolisthetic level was L5 vertebrae.None of them were effective after regular conservative treatment.Eleven of 12 patients were treated surgically through a posterior decompression and instrumented reduction.One case was treated by L5 vertebrectomy and reduction of L4 onto sacrum.Their levels of instrumentations were L4-S1 in 8 patients and L5-S1 in 4 patients.All of 12 patients were fused via interbody fusion.The visual analog scale (VAS),Oswestry disability index (ODI),Japanese Orthopaedic Association (JOA) score,slip angle,percentage slip,lumbar lordosis,sagittal balance were used as outcome measures.Results All of these patients were followed up regularly with an average follow-up of 32 months (6-64 months).Five of these 12 patients suffered postoperative nerve root impairment,including impairment of unilateral and bilateral L5 nerve roots.At the latest follow-up,only 1 case was still suffering from the weakness of unilateral peroneal long and short muscles,the other 4 patients recovered totally.The degree of their spondylolisthesis was reduced Ⅱ degrees or more,and their slip angles decreased from 35.6 degree preoperatively to 9.8 degree postoperatively.The VAS,ODI,JOA,lumbar lordosis and sagittal balance were improved postoperatively.No instrumentation loosening or rupture was found.Conclusions In patients with severe lumbar dysplastic spondylolisthesis,isolated posterior decompression,reduction with internal fixation may lead to a satisfactory clinical outcomes.Surgical reduction is helpful to improve the interbody contact area,thus possibly improve the fusion rate.At the same time,reduction may reduce or correct the lumbar-sacral kyphosis,recover the normal lumbar lordosis and normal sagittal alignment with an excellent cosmetic result.The incidence of the postoperative nerve impairment is high because of the stretching of L5 nerve roots secondary to the reduction,but most of the patients with postoperative nerve impairment may recover gradually.
语种中文
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文献类型期刊论文
条目标识符http://ir.bjmu.edu.cn/handle/400002259/70445
专题北京大学第三临床医学院_骨科
作者单位100191,北京大学第三医院骨科
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GB/T 7714
郭昭庆,陈仲强,齐强,等. 重度发育不良性腰椎滑脱的手术治疗[J]. 中华外科杂志,2014,52(11):845-850.
APA 郭昭庆,陈仲强,齐强,李危石,曾岩,&孙垂国.(2014).重度发育不良性腰椎滑脱的手术治疗.中华外科杂志,52(11),845-850.
MLA 郭昭庆,et al."重度发育不良性腰椎滑脱的手术治疗".中华外科杂志 52.11(2014):845-850.
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