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单枚椎间融合器结合椎弓根螺钉治疗腰椎滑脱症
目的 探讨单牧椎间融合器(cage)结合椎弓根螺钉治疗腰椎滑脱症的临床效果.方法 采用后路椎弓根螺钉及cage治疗腰椎滑脱症31例,男,20例,女11例,年龄27-76岁.单节段29例,双节段2例,其中L3/4 1例,L4/5 15例,L5/S1 14例,双节段L3/4和L4/5 1例.手术方法:-侧症状者采用症状侧椎板关节突显露,双侧症状者采用双侧显露,以症状侧位主,经症状侧或症状较重的-例椎间孔入路(TLIF手术)切除椎间盘及软骨终板,植骨后斜向置入单枚cage.结果 术后获随访26例,随访时间12-48个月,平均21个月.26例均获骨性融合,融合时间6-12个月.术前JOA评分平均10.8分,术后一年时平均24.7分.优18例,良6例,可2例,差0例.优良率92%.并发症发生情况,术中硬膜损伤2例,神经根损伤1例,无断钉及cage移位.结论 单枚cage结合椎弓根螺钉治疗腰椎滑脱能达到良好的复位及牢固的固定,可保持椎间高度和恢复脊柱生物力学稳定性.
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退行性腰椎滑脱的研究现状和进展
退行性腰椎滑脱(degenerative lumbar spondylolisthesis,DLS)是指由于退行性变使椎骨出现变位致使连续性延长,以致上位椎体及椎弓根、横突和上关节突一同在下位椎节上方向前移位,但椎弓完整无峡部崩裂.该病早由Junghanns[1]提出,并称之为"假性腰椎滑脱".1955年Newman[2]对退行性腰椎滑脱的概念做了完整的阐述,后又经过多年的临床研究对本病提出分类.
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腰椎滑脱椎体间植骨固定术后的康复指导
BACKGROUND:Internal fixation of lumbral spondylolisthesis has resolved the problem caused by vertebral translocation and postoperative rehabilitation instruction can prevent moving of bone.Directed to different stages,suitable posture and rehabilitation function exercises can effectively prevent loose intervertebral grafted bone and adhesion of nerve root.
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Posterior lumbar inter-body fusion (PLIF) using autogenous bone and cage with pedicle screw instrumentation versus PLIF using cage with pedicle screw instrumentation in adult spondylolisthesis
Objective: To compare the clinical outcomes of PLIF using autogenous bone and cage with pedicle screw fixation (group 2) and simple cage fusion with pedicle screw fixation (group 1) in adult spondylolisthesis.Methods: 27 patients with minimum follow-up of 24 months, treated by inter-body fusion with pedicle screw fixation were prospectively studied. Disc space height, degree of slippage and fusion rate had been compared before and after operation between the two groups. Results: After minimum 24 month's follow-up, there was no significant difference between the two groups in terms of the amount of blood loss, duration of hospital stay, back pain,radiating pain, fusion rate, or complication (P>0.05). however, there was a significant difference between the two groups in terms of disc space height and percentage of slippage (P<0.05). Conclusion: PLIF using autogenous bone and cage with pedicle screw fixation more beneifical to improve fusion rate and prevent long-term instabilities than simple cage fusion with pedicle screw fixation in adult spondylolisthesis.