創傷性腰椎滑脫癥的臨床特征及手術治療近期療效_《中國修復重建外科雜志》

作者：

四川大學華西醫院骨科（成都，610041）;

關鍵詞：

創傷性腰椎滑脫癥臨床特征后路固定融合術

DOI：

10.7507/1002-1892.20130210

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目的探討創傷性腰椎滑脫癥的臨床特征及經后路手術治療的近期療效。方法回顧分析2008年1月－2012年6月收治的11例創傷性腰椎滑脫癥患者臨床資料。男6例，女5例；年齡13～60歲，中位年齡38歲。致傷原因：重物砸傷4例，高處墜落傷4例，交通事故傷3例。受傷至手術時間3 d～13年，中位時間20 d。術前神經功能Frankel分級為：E級2例，D級4例，C級3例，B級2例。X線片示L4滑脫 3例，L5 8例。根據Meyerding分度：Ⅰ度4 例，Ⅱ度4例，Ⅲ度2例，Ⅳ度1例。手術固定節段：L4、5 2例，L5、S1 7例，L4～S1 2例。行椎間及后外側360°植骨融合8例，僅行后外側植骨3例。術后隨訪行腰椎正側位X線片及CT三維重建評價滑脫復位及植骨融合情況，通過疼痛視覺模擬評分（VAS）及Oswestry功能障礙指數（ODI）進行療效評價。結果術后患者切口均Ⅰ期愈合。11例術后均獲隨訪，隨訪時間6～40個月，中位時間12個月。無內固定物拔出、斷裂等情況發生。CT三維重建顯示患者植骨均融合，融合率100%，融合時間3～6個月，平均4.5個月。末次隨訪時腰椎X線片示滑脫Meyerding分度為0度10例，Ⅰ度1例，與術前比較差異有統計學意義（Z= —2.979，P=0.003）。末次隨訪時神經功能Frankel分級為E級6例，D級3例，C級2例，較術前顯著改善（Z= —2.271，P=0.014）。術后1周及末次隨訪時VAS、ODI評分均較術前顯著改善（P lt; 0.05）；術后1周和末次隨訪間比較差異無統計學意義（P gt; 0.05）。結論急診腰椎X線片發現多發橫突骨折，結合患者受傷機制應高度懷疑創傷性腰椎滑脫癥，盡早行經后路椎管減壓、植骨融合內固定手術有助于創傷性腰椎滑脫癥患者神經功能恢復，獲得滿意近期療效。

引用本文： 楊曦,宋躍明,孔清泉,劉浩,劉立岷,龔全,李濤. 創傷性腰椎滑脫癥的臨床特征及手術治療近期療效. 中國修復重建外科雜志, 2013, 27(8): 965-968. doi: 10.7507/1002-1892.20130210 復制

1.	CLINICAL FEATURE AND P 1 Deniz FE, Zileli M, Ca?li S, et al. Traumatic L4-L5 spondylolisthesis: case report. Eur Spine J, 2008, Suppl 2: S232-235.
2.	RELIMINARY SURGICAL OUTCOME OF TRAUMATIC LUMBAR SPONDYLOLISTHESIS.
3.	Vialle R, Wolff S, Pauthier F, et al. Traumatic lumbosacral dislocation: four cases and review of literature. Clin Orthop Relat Res, 2004, (419): 91-97.
4.	Tsirikos AI, Saifuddin A, Noordeen MH, et al. Traumatic lumbosacral dislocation. Spine (Phila Pa 1976), 2004, 29(8): E164-168.
5.	Vresilovic EJ, Mehta S, Placide R, et al. Traumatic spondylopelvic dissociation. A report of two cases. J Bone Joint Surg (Am), 2005, 87(5): 1098-1103.
6.	Roche PH, Dufour H, Graziani N, et al. Anterior lumbosacral dislocation: case report and review of the literature. Surg Neurol, 1998, 50(1): 11-16.
7.	Ahmed A, Mahesh BH, Shamshery PK, et al. Traumatic retrolisthesis of the L4 vertebra. J Trauma, 2005, 58(2): 393-394.
8.	Saiki K, Hirabayashi S, Sakai H, et al. Traumatic anterior lumbosacral dislocation caused by hyperextension mechanism in preexisting L5 spondylolysis a case report and a review of literature. J Spinal Disord Tech, 2006, 19(6): 455-462.
9.	Vialle R, Charosky S, Rillardon L, et al. Traumatic dislocation of the lumbosacral junction diagnosis, anatomical classification and surgical strategy. Injury, 2007, 38(2): 169-181.
10.	Fabris D, Costantini S, Nena U, et al. Traumatic L5-S1 spondylolisthesis: report of three cases and a review of the literature. Eur Spine J, 1999, 8(4): 290-295.
11.	Zhou TH, Tang X, Xu YQ, et al. Traumatic spondyloptosis of L4. Spine (Phila Pa 1976), 2010, 35(17): E855-859.
12.	Reinhold M, Knop C, Blauth M. Acute traumatic L5-S1 spondylolisthesis: a case report. Arch Orthop Trauma Surg, 2006, 126(9): 624-630.
13.	Lim CT, Hee HT, Liu G. Traumatic spondylolisthesis of the lumbar spine: a report of three cases. J Orthop Surg (Hong Kong), 2009, 17(3): 361-365.
14.	姜為民, 周峰, 唐天駟, 等. 急性創傷性腰椎滑脫. 中華創傷骨科雜志, 2003, 5(4): 395-396.
15.	Lu X, Hou C, Yuan W, et al. Complete traumatic anterior dislocation of the lumbosacral joint: a case report. Spine (Phila Pa 1976), 2009, 34(14): E488-492.
16.	El Assuity WI, El Masry MA, Chan D. Acute traumatic spondylolisthesis at the lumbosacral junction. J Trauma, 2007, 62(6): 1514-1516.
17.	劉鵬, 趙建華, 范偉力, 等. 急性創傷性腰椎滑脫癥的臨床特點與手術療效分析. 創傷外科雜志, 2005, 7(4): 271-273.
18.	周田華, 湯遜, 徐永清, 等. 后路短節段固定加減壓融合治療下腰椎創傷性滑脫. 中國骨與關節損傷雜志, 2009, 24(4): 323-324.
19.	Wangtaphan W, Oo M, Paholpak P, et al. Traumatic lumbosacral spondyloptosis treated five months after injury occurrence: a case report. Spine (Phila Pa 1976), 2012, 37(22): E1410-1414.

1. CLINICAL FEATURE AND P 1 Deniz FE, Zileli M, Ca?li S, et al. Traumatic L4-L5 spondylolisthesis: case report. Eur Spine J, 2008, Suppl 2: S232-235.
2. RELIMINARY SURGICAL OUTCOME OF TRAUMATIC LUMBAR SPONDYLOLISTHESIS.
3. Vialle R, Wolff S, Pauthier F, et al. Traumatic lumbosacral dislocation: four cases and review of literature. Clin Orthop Relat Res, 2004, (419): 91-97.
4. Tsirikos AI, Saifuddin A, Noordeen MH, et al. Traumatic lumbosacral dislocation. Spine (Phila Pa 1976), 2004, 29(8): E164-168.
5. Vresilovic EJ, Mehta S, Placide R, et al. Traumatic spondylopelvic dissociation. A report of two cases. J Bone Joint Surg (Am), 2005, 87(5): 1098-1103.
6. Roche PH, Dufour H, Graziani N, et al. Anterior lumbosacral dislocation: case report and review of the literature. Surg Neurol, 1998, 50(1): 11-16.
7. Ahmed A, Mahesh BH, Shamshery PK, et al. Traumatic retrolisthesis of the L4 vertebra. J Trauma, 2005, 58(2): 393-394.
8. Saiki K, Hirabayashi S, Sakai H, et al. Traumatic anterior lumbosacral dislocation caused by hyperextension mechanism in preexisting L5 spondylolysis a case report and a review of literature. J Spinal Disord Tech, 2006, 19(6): 455-462.
9. Vialle R, Charosky S, Rillardon L, et al. Traumatic dislocation of the lumbosacral junction diagnosis, anatomical classification and surgical strategy. Injury, 2007, 38(2): 169-181.
10. Fabris D, Costantini S, Nena U, et al. Traumatic L5-S1 spondylolisthesis: report of three cases and a review of the literature. Eur Spine J, 1999, 8(4): 290-295.
11. Zhou TH, Tang X, Xu YQ, et al. Traumatic spondyloptosis of L4. Spine (Phila Pa 1976), 2010, 35(17): E855-859.
12. Reinhold M, Knop C, Blauth M. Acute traumatic L5-S1 spondylolisthesis: a case report. Arch Orthop Trauma Surg, 2006, 126(9): 624-630.
13. Lim CT, Hee HT, Liu G. Traumatic spondylolisthesis of the lumbar spine: a report of three cases. J Orthop Surg (Hong Kong), 2009, 17(3): 361-365.
14. 姜為民, 周峰, 唐天駟, 等. 急性創傷性腰椎滑脫. 中華創傷骨科雜志, 2003, 5(4): 395-396.
15. Lu X, Hou C, Yuan W, et al. Complete traumatic anterior dislocation of the lumbosacral joint: a case report. Spine (Phila Pa 1976), 2009, 34(14): E488-492.
16. El Assuity WI, El Masry MA, Chan D. Acute traumatic spondylolisthesis at the lumbosacral junction. J Trauma, 2007, 62(6): 1514-1516.
17. 劉鵬, 趙建華, 范偉力, 等. 急性創傷性腰椎滑脫癥的臨床特點與手術療效分析. 創傷外科雜志, 2005, 7(4): 271-273.
18. 周田華, 湯遜, 徐永清, 等. 后路短節段固定加減壓融合治療下腰椎創傷性滑脫. 中國骨與關節損傷雜志, 2009, 24(4): 323-324.
19. Wangtaphan W, Oo M, Paholpak P, et al. Traumatic lumbosacral spondyloptosis treated five months after injury occurrence: a case report. Spine (Phila Pa 1976), 2012, 37(22): E1410-1414.

《中國修復重建外科雜志》

創傷性腰椎滑脫癥的臨床特征及手術治療近期療效

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《中國修復重建外科雜志》

創傷性腰椎滑脫癥的臨床特征及手術治療近期療效

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