张发惠;宋一平;张传开;陈惠萍;李平;朱云;孙阳;韩冰;

• 1:南京军区福州总院476医院
• 2:解放军第97医院南京军区创伤修复中心

摘要(Abstract)：

[目的]总结多孔面螺钉单个椎体内固定治疗腰椎峡部裂脊椎滑脱的临床远期疗效,以及对固定椎邻近节段的影响。[方法]1991年1月～2011年1月,本院骨科采用多孔面螺钉经狭部固定治疗腰椎峡部裂脊柱滑脱患者217例,117例患者得到随访,平均随访8.2±7.8年。男90例,女27例;年龄16～61岁,平均(40.8±18.2)岁。所有病例均为双侧峡部裂,其中L3椎体峡部裂17例,L4椎体峡部裂31例,L5椎体峡部裂69例,无滑脱100例,伴Ⅰ°滑脱10例,Ⅱ°滑脱7例。所有病例采用神经根管减压,峡部硬化骨、瘢痕组织切除术+神经粘连松解+峡部植骨+多孔面螺钉内固定术。[结果]本组117例,手术时间(64.33±13.28)min,术中失血量(117.31±22.50)ml。随访时,112例症状完全消失,恢复术前工作,腰部活动不受限。Oswestry功能障碍指数由术前(28.37±3.99)减少至随访时(5.33±2.70),术前与随访时差异有统计学意义(P<0.01)。JOA评分由术前(19.00±2.78)增加至随访时(28.08±1.04),术前与随访时差异有统计学意义(P<0.01)。117例患者的治疗改善率90.34%。术后6个月后摄片复查均见峡部缺损处有骨小梁通过,峡部愈合率达99%,腰椎滑脱纠正率达80%。所有病例未出现螺钉松动及断裂现象,未发生邻近节段退变等并发症。[结论]多孔面螺钉设计符合生物力学特征,其材质符合人体生理特性,能永久植入体内。通过直接修复峡部断裂,重建脊柱单个运动单元的完整性,避免了松动、断钉以及邻近节段病的发生。

关键词(KeyWords)： 腰椎;脊椎滑脱;峡部裂;多孔面螺钉内固定;邻近节段病

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 张发惠;宋一平;张传开;陈惠萍;李平;朱云;孙阳;韩冰;

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