www.medenosrce.net/arhimed   arhimed(a-t>medenosrce.net   [22/04/2026 01:28:30] http://www.medenosrce.net/arhimed/poglej.asp?id=145 DOLGOROCNI KLINICNI REZULTATI PO SPONDILODEZI LEDVENOKRIŽNICNE HRBTENICE Avtor: Janez Plestenjak Mentor: prof. dr. Srecko Herman Somentor: asist. mag. Rok Vengust IZHODIŠCE: Za operativno zatrditev ledvenokrižnicne hrbtenice obstajajo razlicne indikacije, med katerimi so najpogostejše: boleca spondiloliza z ali brez spondilolisteze, spinalna stenoza in segmentna nestabilnost. Zatrditev hrbtenice, ki je lahko bodisi posterolateralna bodisi interkorporalna, onemogoca premike med posameznimi gibalnimi segmenti. Ob zatrditvi se navadno hrbtenica tudi fiksira, kar znatno izboljša uspešnost zatrditve in dolgorocne klinicne rezultate v primerjavi z zatrditvijo brez fiksacije. Ker je izbira operativnega posega odvisna od razlicnih predoperativnih dejavnikov in ker so dolgorocni klinicni rezultati med razlicnimi tipi posegov med seboj primerljivi, literatura ne daje natancnih napotkov o vrsti zatrditve in fiksacije pri specificni patologiji. Tako se o vrsti operativnega posega pogosto odloca individualno glede na relativno ohlapne napotke v literaturi in glede na predoperativno patologijo. NAMEN: Namen tega dela je bil primerjati dolgorocne klinicne rezultate pri razlicnih indikacijah za operacijo, razlicnih vrstah spondilodeze in fiksacije ledvenokrižnicne hrbtenice z rezultati v literaturi. HIPOTEZA: Delovna hipoteza, ki smo jo poskušali potrditi je bila, da so dolgorocni klinicni rezultati pri razlicnih vrstah deze in fiksacije in razlicnih diagnozah medseboj primerljivi. METODE: Raziskava je bila retrospektivna, v njo smo vkljucili 36 bolnikov pri katerih je bila narejena spondilodeza ledvenokrižnicne hrbtenice na Ortopedski kliniki v Ljubljani med letoma 1989 in 1999. Uporabili smo podatke in rentgenograme iz arhiva Ortopedske klinike in podatke in rentgenograme pridobljene pri ponovnem klinicnem pregledu v letih 2002 in 2003. Vsi preiskovanci so izpolnili tudi vprašalnike Oswestry, SF - 36 in vizualno analogno lestvico. Rezultate smo obdelali z multivariatno metodo analize podatkov. REZULTATI: Ugotovili smo, da razlika med dolgorocnimi klinicnimi rezultati pri razlicnih vrstah deze in fiksacije in razlicnih diagnozah v naši študiji ni statisticno pomembna (p > 0,05). ZAKLJUCKI: Z omenjenimi rezultati smo pokazali, da dolgorocni klinicni rezultati niso odvisni od vrste deze in fiksacije iz cesar sledi, da lahko v vecini primerov izberemo primerno vrsto operacije na podlagi ohlapnih navodil iz literature vendar na nacin, ki je za bolnika najmanj zahteven. Rezultati naše študije so primerljivi s tistimi v literaturi. «» [Abstract / English version] DOLGOROCNI KLINICNI REZULTATI PO SPONDILODEZI LEDVENOKRIŽNICNE HRBTENICE Author: Janez Plestenjak Mentor: prof. dr. Srecko Herman Co-mentor: asist. mag. Rok Vengust BACKGROUND: There are many indications for fusion of lumbosacral spine and the most common are: painful spondylolisis with or without spondylolisthesis, spinal stenosis and segmental instability. The aim of spinal fusion, which can be either posterolateral or interbody, is to prevent mobility between individual motion segments. Spinal fusion is usually supported by instrumentation. Long term clinical outcome for fusion with instrumentation is better compared to fusion alone. Since the choice of operative technique depends on different preoperative factors and because long term clinical results are comparable for different operative techniques, the literature does not give specific directions which kind of fusion and instrumentation should be used for specific pathology. Therefore the decision about the appropriate operation technique is frequently made individually, depending on the preoperative pathology and relatively loose guidelines given in the literature. AIM: The aim of this work was to compare long term clinical outcomes for different indications for operation, different types of fusion and fixation of lumbosacral spine, with the results given in the literature. HYPOTHESIS: We tried to verify the validity of the hypothesis that long term clinical outcome for different diagnosis and types of fusion and fixation are comparable between themselves. METHODS: The study was retrospective and included 36 patients who had fusion and fixation of the lumbosacral spine from 1989 to 1999 and were treated at the Department of Orthopaedic Surgery in Ljubljana. We used data from medical records from the archives and all patients were clinically re-examined between 2002 and 2003 and had their roentgenographic images of lumbosacral spine taken. All patients completed each of these three questionnaires: Oswestry Disability Index, SF-36 and Visual Analog Scale. The results were analyzed using a multivariate method. RESULTS: We have found out that the difference between long term clinical outcome for different types of fusion and instrumentation and different indications for operation is not statistically significant (p > 0,05). CONCLUSIONS: The results of our study show that long term clinical outcome is not dependant on type of fusion and instrumentation, which means that in most cases the appropriate type of operation can be chosen from loose guidelines given in the literature, however in a manner that is least demanding for the patient. The results of our study are comparable with those given in literature.