椎弓根内固定加椎体间与后外侧联合植骨融合治疗腰椎滑脱症

Treatment of lumbar spondylolisthesis with transpedicle fixation combined with intervertebral and posterolateral fusion

目的探讨采用椎弓根内固定加椎体间与后外侧联合植骨融合治疗腰椎滑脱症的临床效果。方法采用椎弓根内固定并椎体间与后外侧联合植骨融合治疗真性腰椎滑脱症并获得随访69例。其中,男29例,女40例。平均年龄46.9(39～65)岁。平均病史4.1(1.5～16)年。滑脱节段为:L_3、L_4、L_5分别为4、41、22例,L_4、L_5双节段滑脱2例。全部患者均有明显症状与体征,长期保守治疗效果不佳。按照Meyerding分类,Ⅰ、Ⅱ、Ⅲ度滑脱分别为46、22、1例。均采用后路椎弓根内固定系统复位,同时行椎体间与后外侧联合植骨。其中,椎体间植入cage者29例,植入骨块者40例。结果平均随访3.8(0.5～5.5)年。术后疼痛缓解,功能改善。手术复位率92.8%,椎间高度恢复。均获得骨性融合。植骨愈合时间平均4.5(3～6)个月。无内固定物折断、神经损伤及感染。按日本骨科学会(JOA)评分法进行评定,结果:优39例,良26例,可4例。总优良率94.2%。结论椎弓根内固定加椎体间与后外侧联合植骨融合是治疗腰椎滑脱症的良好方法。

Objective To investigate the clinical effect of treatment of with pedicle fixation combined with intervertebral and posterolateral fusion.Methods 69 patients suffered from lumbar spondylolisthesis,obtained followed up, were treated with pedicle fixation combined with intervertebral and posterolateral fusion.There were 29 male and 40 female in this group.The average age was 46.9 years with a range from 39 to 65 years.The mean history was 4.1 years with a range from 1.5 to 16 years.Sliding vertebrae was L_3 in 4 cases,L_4 in 41 cases,and L_5 in 22 cases respectively.Others, sliding vertebrae both of L4 and L5 were seen in 2 cases.The symptoms and signs are clear,long-term effect of conservative treatment was poor.According to Meyerding classification,Ⅰ,Ⅱ,Ⅲdegree spondylolisthesis were 46,22,1 cases respectively.The reset used posterior transpedicle fixation system,and then combined with intervertebral and posterolateral fusion with cages or bone grafting.Among them,intervertebral implants cage were used in 29 cases and bone piece used in 40 cases.Results The period of postoperative follow-up studies from 0.5-5.5 years with an average of 3.8 years.The pain was relief and function got improvement after the operation.Surgical reduction rate was 92.8%.The intervertebral space height was restoration.The bony fusion was seen in all patients.The mean time of bony fusion was 4.5 months with a range of 3 to 6 months.There was none of implant fracture,nerve injury and infection.According to the Japanese Orthopedic Institute(JOA)score the results were assessed as follows:excellent in 39 cases,good in 26 cases,and fair in 4 cases. The total rate of excellent and good was 94.2%.Conclusion The pedicle fixation combined with intervertebral and posterolateral fusion is suitable method to treat the lumbar spondylolisthesis.