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find Author "付鹏军" 2 results
  • LUMBAR INTERBODY FUSION IMPACTED BONE GRAFTS COMBINED WITH REGRAFTING IN SITU WITH SPINOUS PROCESS AND VERTEBRAL PLATE COMPLEX AND PEDICLE SCREW FIXATION FOR LUMBAR DEGENERATIVE INSTABILITY

    Objective To evaluate the effectiveness of lumbar interbody fusion impacted bone grafts combined with regrafting in situ with spinous process and vertebral plate complex and pedicle screw fixation for lumbar degenerative instabil ity. Methods Between January 1998 and October 2010, 48 patients with lumbar degenerative instabil ity were treated by posterior decompression, lumbar interbody fusion impacted bone grafts combined with regrafting in situ with spinous processand vertebral plate complex and pedicle screw fixation. There were 26 males and 22 females, aged 52-76 years (mean, 62.4 years). The disease duration was 7 months to 25 years (mean, 6.5 years). One segmental instabil ity was located at L3, 4 in 1 case, at L4, 5 in 10 cases, and at L5, S1 in 11 cases; multi-segmental instabil ity was located at L3, 4, L4, 5, and L5, S1 in 5 cases, at L2, 3 and L3, 4 in 2 cases, at L3, 4 and L4, 5 in 10 cases, and at L4, 5 and L5, S1 in 9 cases. Of 48 patients, 32 complicated by lumbar disc herniation, 46 by lumbar spinal stenosis, and 16 by degenerative scol iosis. The cl inical results were evaluated by the Japanese Orthopaedic Association (JOA) score, recovery rate, disc height, and lumbar lordosis angles. Results The incisions obtained healing by first intention after operation. No nerve injury, rod or screw breakage, and infection occurred during and after operation. All 48 patients were followed up 1 to 6 years. The fusion time was 12-18 weeks (mean, 16.2 weeks). Vertebra sl i pping or degenerative scol iosis was corrected, and spinal column series became normal. At preoperation, 6 months after operation, and last follow-up, the disc heights were (5.2 ± 2.3), (11.9 ± 2.0), and (11.6 ± 2.1) mm, respectively; the JOA scores were 3.2 ± 2.1, 12.8 ± 1.6, and 13.6 ± 1.2, respectively; and the lumbar lordosis angles were (—20.5 ± 10.5), (30.5 ± 8.5), and (31.2 ± 5.6)°, respectively. The JOA scores, disc heights, and lumbar lordosis angles were significantly improved at 6 months after operation and last follow-up when compared with preoperative ones (P lt; 0.05), but no significant difference was found between 6 months after operation and last follow-up (P gt; 0.05). The recovery rate of JOA was excellent in 36 cases, good in 10 cases, and fair in 2 cases at 6 months after operation, with an excellent and good rate of 95.8%. Conclusion Lumbar interbody fusion impacted bone grafts combined with regrafting in situ with spinous process and vertebral plate complex and pedicle crew fixation for lumbar degenerative instabil ity can restore and maintain the intervertebral disc height effectively with high fusion rate. It is a plasty close to anatomic reconstruction.

    Release date:2016-08-31 04:23 Export PDF Favorites Scan
  • 后路全脊椎截骨联合椎弓根钉棒固定术治疗脊柱后凸畸形

    目的 总结后路全脊椎截骨联合椎弓根钉棒固定术治疗胸腰椎脊柱后凸畸形的手术方法及临床疗效。 方法 2003 年1 月- 2008 年1 月,采用后路全脊椎截骨联合椎弓根钉棒固定术治疗脊柱后凸畸形24 例。男15 例,女9 例;年龄21 ~ 68 岁,平均53 岁。先天性脊柱畸形2 例,结核性后凸9 例,陈旧创伤性后凸13 例。Frankel 分级:E 级14 例,D 级8 例,C 级2 例。后凸顶点分别位于:T11 5 例,T12 10 例,L1 7 例,L2 2 例。脊柱后凸Cobb 角为37 ~ 65°,平均46°。 结果 术后24 例均获随访,随访时间8 个月~ 3 年,平均2.5 年。根据自定评价标准,疗效优15 例,良7 例,可2例,优良率91.7%。术后3 个月Cobb 角为4.2 ~ 5.1°,平均5.3°,平均矫正率87.6%。术后2 例Frankel C 级均恢复至D 级;8 例D 级中5 例恢复至E 级,3 例无变化;余患者仍为E 级。术后8 ~ 12 个月X 线片可见原截骨平面发生骨性融合,未发现内植物松动、断裂、假关节形成和矫正度数丢失等并发症。 结论 后路全脊椎截骨联合椎弓根钉棒固定术损伤小、并发症少,减压、矫形可同时进行,治疗脊柱后凸畸形临床效果明显。

    Release date:2016-09-01 09:05 Export PDF Favorites Scan
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