DEVEX椎间融和器联合椎弓根螺钉系统治疗腰椎不稳症

Treatment of lumbar degenerative instability with combined DEVEX-cage and pedicle screw system

  • 摘要: 目的 探讨DEVEX椎间融和器联合椎弓根螺钉固定治疗腰椎不稳症的临床疗效。方法 回顾2007年11月-2009年12月采用DEVEX椎间融和器联合椎弓根螺钉系统治疗退行性腰椎不稳患者23例,男10例,女13例,共26个间隙;年龄39-68岁,平均46.6岁。腰椎动力位X线片示所有患者存在腰椎不稳,其中L3-4不稳1例,L4-5不稳11例,L5-S1不稳8例,L4-5/L5-S1不稳3例。结果 手术时间为1.5-2.3h,平均1.8h。术中出血量150-260ml,平均180.7ml。术中无硬脊膜损伤,术后无脑脊液漏、神经功能损伤等并发症。23例随访13个月-4年,平均3.2年。患者术前Oswestery功能障碍指数(ODI)评分(41.37±3.68)分,术后1周(11.25±2.21)分,术后3个月(9.98±2.08)分,末次随访(9.06±2.68)分。术后1周、3个月及末次随访ODI指数均较术前显著下降(P<0.01)。21例(22间隙)植骨融合良好,2例(4间隙)植骨可能融合。2例术后存在腿部疼痛,予保守治疗后好转。结论 DEVEX椎间融和器联合椎弓根螺钉固定,创伤较小、安全性较高、近期效果较好,是治疗退变性腰椎不稳症的良好方法。

     

    Abstract: Objective To study the clinical efficacy of combined DEVEX-cage and pedicle screw fixation for lumbar degenerative instability. Methods Twenty-three patients with lumbar degenerative instability(10 males,13 females) at the age of 39-68 years(mean 46.6 years) were treated with combined DEVEX-cage and pedicle screw fixation from November 2007 to December 2009.Preoperative lumbar dynamic X-ray showed lumbar degenerative instability at L3-4 in 1 patient,at L4-5 in 11 patients,at L5-S1 in 8 patients,and at L4-5/L5-S1 in 3 patients,respectively. Results The operation time was 1.5-2.3h(mean 1.8h).The intra-operation blood loss was 150-260ml(mean 180.7ml).No injury of dural matter,cerebrospinal fluid leakage,and nerve system occurred.The patients were followed up for 13 months-4 years(mean 3.2 years).The ODI score was 41.37±3.68 before operation,11.25±2.21 one week after operation,9.98±2.08 three months after operation,and 9.06±2.68 at the final follow-up time after operation.The mean ODI score was significantly lower 1 and 3 months after operation and at the final follow-up time after operation than before operation(P<0.01).Good bony union was achieved in 22 patients and possible bony union was achieved in 2 patients.Mild 1eg pain developed in 2 patients after operation,which was improved after conservative treatment. Conclusion Combined DEVEX-cage and pedicle screw fixation is a good procedure for lumbar degenerative instability with a mild injury,a high safety and a good short-term effect.

     

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