后路环状融合术在腰椎滑脱症外科手术中的应用【临床医学毕业论文设计精品doc】.DOC

后路环状融合术在腰椎滑脱症外科手术中的应用【临床医学毕业论文设计，精品doc】.DOC 临床医学论文-后路环状融合术在腰椎滑脱症外科手术中的应用 【摘要】 探讨后路环状融合术（PCF） 联合短节段椎弓根螺钉系统内固定治疗腰椎滑脱症（LSL） 的可行性、 方法及临床疗效。 ［ 方法］ 从 2002 年 10 月2006年 3 月， 对 44 例 LSL 患者采纳腰椎管减压、 环状植骨融合及短节段椎弓根螺钉内固定手术进行治疗。 男 15 例， 女 29 例； 年龄 3168 岁， 平均 48 6 岁。 全部患者术前均经 X 线和 CT 证明为腰椎滑脱合并椎管狭窄。 按 Newman 分型 退变性滑脱 15 例， 峡部裂性滑脱 29 例。 按 Meyerding 分级 Ⅰ 度滑脱 17 例， Ⅱ 度滑脱 24 例， Ⅲ度滑脱 3 例。 L4、 5 滑脱 18 例， L5S1 滑脱 26 例。 ［ 结果］ 全部病例随访 1836 个月， 平均 26 个月。 17 例Ⅰ 度滑脱术后全部解剖复位； 24 例Ⅱ度滑脱中 6 例遗留Ⅰ 度滑脱； 3 例Ⅲ度滑脱中 2 例遗留Ⅰ 度滑脱。 依据侯树勋临床疗效评价标准， 优28 例， 良 13 例， 可 3 例， 优良率达 93 2。 无内固定松动断裂和神经根与马尾神经损伤并发症。 术后 310 个月植骨均获骨性愈合， 平均 4 2 个月。 随访期间椎间隙高度维持良好， 滑脱椎体复位无丢失。 ［ 结论］PCF 联合短节段椎弓根螺钉系统内固定是治疗 LSL 的一种牢靠方法， 能够提高脊柱的融合率并维持良好的椎间隙高度和形态及腰椎生理性前凸。 满足的临床效果依靠于全面驾驭 PCF 和短节段椎弓根螺钉固定的技术特点。 【关键词】 腰椎滑脱症 椎管减压 后路环状融合术 椎弓根螺钉系统 Abstract ［ Obj ective］ To uate the feasibilitiy,s and therapeautical effects of the posterior circumferential fusion PCF combined with short -segmental pedicle screw system fixation for the treatment of lumbar spondylolisthesisLSL ［ ］ From October 2002 to March 2006, 44 cases of LSL were treated with decompression for spine canal stenosis, circumferential fusion and short- segmental pedicle screw system fixation There were 15 male and 29 female, average age was 48 6 ranged, 3168 years The diagnoses of LSL and stenosis were confirmed by X-ray and CT According to Newman classification, 15 of them were the degenerative type and 29 were isthmic type According to Meryerding classification of LSL, 17 patients had degree I, 24 patients had degree Ⅱ and 3 patients had degree Ⅲ spondylolisthesis The levels of LSL was between L4 and L5,in 18 patients and between L5 and S1 in 26 cases ［ Result］ The follow-up period was 1836 months , averaged 26 months Seventeen patients with degree Ⅰ spondylolisthesis were all reduced anatomically after surgery Twenty-four patients with degree Ⅱ spondylolisthesis were reduced anatomically except for 6 patients with Ⅰ degree residual spondylolisthesis 3 patients with degree Ⅲ spoadylolisthesis were reduced anatomically except for 2 spatients with Ⅰ degree residual spondylolishesis The effect was uated according to Hou Shuxun＇ s uation standard, the results were excellent in 28 cases, good in 13 cases, and fair in 3 cases The excellent and good rate was 93 2 No complication such as interfixation failure and nerve pedicle inj ury or cauda equine inj ury were found All cases got bony union in 3 to 10 months mean 4 2 months postoperatively All patients had normal disc height and no loss of spondylolisthesis reduction ［ Conclusion］ The PCF combined with short-segmental pedicle screw system fixation is reasonable options in treating the LSL It can improve the fusion rate of the spine and maintain good interverteb