Chinese Journal of Tissue Engineering Research ›› 2017, Vol. 21 ›› Issue (23): 3688-3693.doi: 10.3969/j.issn.2095-4344.2017.23.014
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Chen Kang-wu, Zhang Kai, Chen Hao, Wang Gen-lin, Zhu Xiao-yu, Qian Zhong-lai, Yang Hui-lin
Online:
2017-08-18
Published:
2017-09-01
Contact:
Yang Hui-lin, Professor, Chief physician, Doctoral supervisor, Department of Orthopedics, the Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
About author:
Chen Kang-wu, Master, Attending physician, Department of Orthopedics, the First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
Supported by:
the General Project of the Jiangsu Provincial Natural Science Foundation of the Universities, No. 16KJD320004; the Suzhou Young Science and Technology Project, No. kjxw2014009
CLC Number:
Chen Kang-wu, Zhang Kai, Chen Hao, Wang Gen-lin, Zhu Xiao-yu, Qian Zhong-lai, Yang Hui-lin. Pedicle screw fixation combined with posterior lumbar interbody fusion for degenerative lumbar spondylolisthesis in the elderly[J]. Chinese Journal of Tissue Engineering Research, 2017, 21(23): 3688-3693.
2.3 内固定效果分析 30例高龄退行性腰椎滑脱症患者均顺利完成手术。平均住院时间为(16.6±2.9) d(9-41) d,术前平均住院时间为(4.9±1.2) d(2-18 d)。平均手术时间(225.6±23.4) min,平均术中出血量(470±45.5) mL。手术固定范围:L4-L5 18例、L3-L5 5例、L4-S1 3例、L2-L5 2例、L3-S1 2例;融合节段:1节段24例(L4-5 23例、L5-S1 1例)、2节段3例(L3-L5 2例、L4-S1 1例)、3节段3例(L2-L5 2例、L3-S1 1例)。其中有1例患者诊断为L3椎体退行性滑脱(Ⅰ度)合并L4-5椎间盘突出症,予以L3-5椎弓根螺钉内固定、椎管减压和椎间融合术,手术疗效满意(图2)。"
2.4 疗效评价 内固定后目测类比评分为显著优于内固定前,差异均有显著性意义(P < 0.05); 内固定后后ODI指数与腰椎JOA评分较内固定前前有明显改善(P < 0.05),见表2。 腰椎JOA评分改善率情况:治愈3例,显著有效24例,有效3例,无效0例。 根据椎间融合判定标准,所有患者均达到骨性融合,平均融合时间为4-8(5.13±0.65)个月。 2.5 不良反应 围手术期无全身伴发疾病相关并发症发生,有6例(20%)患者出现手术相关并发症。其中1例硬膜囊撕裂,术后发生脑脊液漏,予以头低足高位,术后3 d拔除引流管,紧密缝合引流口,2周后切口愈合良好;2例麻痹性肠梗阻,经胃管减压、灌肠等保守治疗后缓解。3例患者出现一过性神经症状加重,经用脱水、小剂量激素、营养神经等治疗后缓解。随访期间无椎间融合器移位、椎弓根螺钉松动或断裂等并发症发生。 "
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