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find Keyword "退变性腰椎失稳" 2 results
  • SURGICAL TREATMENT OF DEGENERATIVE LUMBAR INSTABILITY BY MINIMALLY INVASIVE TRANSFORAMINAL LUMBAR INTERBODY FUSION

    Objective To investigate the effectiveness of surgical treatment for single-level degenerative lumbar instabil ity (DLI) by comparing traditional open transforaminal lumbar interbody fusion (TLIF) with minimally invasive TLIF. Methods Between March 2007 and May 2009,87 patients with single-level DLI were treated by traditional open TLIF (group A, n=45) and by minimally invasive TLIF (group B, n=42), respectively. There was no significant difference in gender, age, disease duration, segment level, combined diseases of lumbar spine, or the proportion of uni- and bilateral symptom between 2groups (P gt; 0.05). The indexes of surgical trauma,systemic inflammatory response, cl inical outcomes, and aravertebral muscle injury were compared between 2 groups. Results Operation was performed successfully in all patients. The patients were followed up 2.9 years on average in group A and 2.8 years on average in group B. The incision, blood loss, and postoperative drainage in group B were significantly less than those in group A (P lt; 0.05), but the operation time in group B was significantly longer than that in group A (P lt; 0.05). There were significant differences (P lt; 0.05) in C-reactive protein, leucocyte count, and creatine kinase MM between 2 groups at 24 hours postoperatively as well as in C-reactive protein at 6 days postoperatively; group B was superior to group A. At last follow-up, the Oswestry disabil ity index (ODI) and visual analogue score (VAS) were significantly improved when compared with the preoperative scores in 2 groups (P lt; 0.05). There were significant differences in ODI and back pain VAS score (P lt; 0.05), but no significant difference in leg pain VAS score (P gt; 0.05) between 2 groups. At last follow-up, no low back pain occurred in 8 and 18 cases, mild in 25 and 18 cases, moderate in 9 and 6 cases, and severe in 3 and 0 cases in groups A and B, respectively, showing that low back pain was significantly l ighter in group B than in group A (Z= —2.574, P=0.010). At last follow-up, the atrophy ratio of multifidus muscle was 37% ± 13% in group A and was 15% ± 7% in group B, showing significant difference (t=12.674, P=0.000). The multifidus muscle atrophy was rated as grade I in 18 and 44 sides, as grade II in 42 and 32 sides, and as grade III in 30 and 8 sides in groups A and B, respectively, showing significant difference (Z= — 4.947, P=0.000). Conclusion Both traditional open TLIF and minimally invasive TLIF are the effective treatments for single-level DLI. Minimally invasive TLIF has less surgical trauma, sl ighter postoperative systemic inflammatory response, less paravertebral muscle injury, and lower incidence of postoperative back pain, but it has longer operation time.

    Release date:2016-08-31 05:42 Export PDF Favorites Scan
  • 改良腰椎后路椎间植骨融合术治疗退变性腰椎失稳

    目的  总结改良腰椎后路椎间植骨融合术(posterior  lumbar  interbody  fusion,PLIF)治疗退变性腰椎失稳的疗效。  方法   2006 年 5 月- 2008 年 1 月,采用改良 PLIF 治疗退变性腰椎失稳患者 36 例。男 21 例,女 15 例;年龄 38 ~ 61 岁,平均 48.7 岁。病程 6 ~ 26 个月。病变位于 L3、 4 2 例, L4、 5 16 例, L5、 S1 13 例, L4 ~ 5、 S1 5 例。术后定期随访评估临床疗效、植骨融合率和椎间隙高度。  结果  1例术后1周出现切口急性金黄色葡萄球菌感染,对症治疗后痊愈;余 35 例切口Ⅰ期愈合。36 例均获随访,随访时间 16 ~ 26 个月,平均 18 个月。术后 1 年薄层螺旋 CT 扫描三维重建可见完全的骨小梁连接,达骨性融合。术前椎间隙高度为(9.5 ± 1.2)mm,术后 7 d 为(11.2 ± 1.1)mm,末次随访时为(11.0 ± 1.1)mm,手术前后比较差异均有统计学意义(P lt; 0.01),术后 7 d 与末次随访比较差异无统计学意义(P gt; 0.05)。采用日本骨科协会(JOA)下腰痛评分标准,获优 29 例,良 5 例,中 2 例,优良率 94.4%。  结论  改良 PLIF 治疗退变性腰椎失稳最大限度保留了后柱结构,创伤小,植骨融合率高,椎间隙高度维持良好,临床疗效满意。

    Release date:2016-08-31 05:47 Export PDF Favorites Scan
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