椎弓崩裂滑脱症的手术治疗(附124例报告)

The Surgical treatment of spondylolisthesis

目的 评价单纯减压植骨融合与复位减压植骨融合治疗椎弓崩裂滑脱症的疗效。方法 回顾 1 977年以来 1 2 4例椎弓崩裂滑脱症 (男 41例 ,女 83例。年龄 31岁～ 72岁。平均 47 3岁 )采用减压植骨融合 (n =69)、复位减压植骨融合 (n =55) ,作疗效评定。结果 全部病例 1年内复查 ,术前症状消除、植骨融合。获长期随访 83例 ,时间 1 6年～ 2 2年 ,平均 1 3 1年。减压植骨组 46例 ,优 32例 ,良 1 1例 ,可 3例 ;复位减压植骨组 37例 ,优 2 5例 ,良 8例 ,可 4例。出现并发症 :取髂骨处积血 3例、皮下脂肪液化 2例。结论 椎弓崩裂滑脱症手术关键在于彻底减压、可靠融合和术后良好外固定 ,与是否复位关系不大 ;滑椎复位内固定有利于消除腰部台阶样改变 ,对腰率 <75 % ,出现骶骨前上缘弯曲率者宜复位内固定 ;滑椎复位要避免追求完全复位 。

Objective To evaluate the operative effect of the treatment of spondylolisthesis with reduction decompression bone grafting and with only decompression bone grafting.Methods Since 1977, the results of 124 cases with spondylolisthesis (41 males and 83 females, the age ranged 31 to 72 years and averaged 47.3 years) were reviewed. Decompression bone grafting was adopted in group Ⅰ(n=69), reduction decompression bone grafting was adopted in groupⅡ(n=55). Results All cases were followed up in 1 year, the signs of preoperation were eliminated and the bone grafting was union. The 83 cases were followed up for an average of 13.1 years (range, 1.6～22 years). 46 cases were in group Ⅰ, 32 cases were excellent, 11 cases were good and 3 cases were fair; 37 cases were in group Ⅱ, 25 cases were excellent, 8 cases were good and 4 cases were fair. There was some complication: blood store was in the location of iliac graft in 3 cases; the fat liquefaction under the skin was in 2 cases. Conclusions ① Entire decompression? adapt fusion and good external fixation was the important technique for the treatment of spondylolisthesis, and it won't make much difference whether reduction. ②Reduction and fixation of the lumbar spondylolis thesis was favourable to the elimination of the staged change in the back. If the lumbar rate was less than 75% or the above front of the sacrum was curve shape, reduct ion and fixation would be suitable. ③ The nerve injury would be avoided when the spondylolisthesis was reduced.