椎弓根系统固定加后路减压融合治疗腰椎滑脱

Treatment of lumbar spondylolisthesis with posterior decompression, spinal fusion and pedicle screws instrumentation

目的 评价采用后路椎管减压、椎体融合和椎弓根螺钉复位内固定系统治疗腰椎滑脱的疗效。方法 对 44例腰椎滑脱患者 ,采用全椎板减压、RF -Ⅱ或SOCON脊柱内固定系统复位固定 ,并辅以后路椎体间植骨融合或椎体间融合器技术进行治疗。术后随访观察临床症状和体征 ,定期摄X线片 ,并与术前比较。结果 术后随访时间为 6～ 2 6个月 ,平均 16.4个月 ,3 2例Ⅰ°滑脱和 9例Ⅱ°滑脱完全复位 ,3例Ⅱ°滑脱复位达 90 %。滑脱椎体均获得骨性融合。 2 2例患者腰腿疼症状体征消失 ,17例基本消失 ,优良率为 88.6%。无内固定松动、断裂及神经损伤等并发症 ,无一例患者术后出现症状加重。结论 在腰椎滑脱治疗过程中采用彻底减压 ,并进行椎间融合 ,辅以坚强的内固定 。

Objective To evaluate the clinical effect of lumbar spondylolisthesis treated by laminectomy decompression,vertebral body fusion and pedicle screws fixation devices.Methods From July 1998 to Dec.2001,44 cases of lumbar spondylolisthesis were included in this study.According to Meyerding classification,roentgengram showed that there were 32 cases of grade Ⅰ°, 12 cases of grade Ⅱ°. All patients were treated with decompression of total laminectomy and bilateral nerve canal,intertransverse process arthrodesis were managed by means of bone chip grafting, interbody fusion was done with cylindrical auto-iliac bone or cage filled with autograft,and RF-Ⅱ system or SOCON pedicle instrument was used in reduction and internal fixation.Results The patients were followed up from 6 months to 26 months (mean 16.4 months).Thirty-two cases of grade Ⅰ° and 9 cases of grade Ⅱ° spondylolisthesis achieved anatomic reduction of slide intervertebral bodies, and 3 cases of grade Ⅱ°obtained 90% reduction.All the operative intervertebral bodies achieved successful fusion and bony union.The pre-operative symptoms and signs completely disappeared in 22 of 44 cases and nearly disappeared in 17 of 44 cases.No complication of pedicle screws loosening or broken and peripheral nerve dysfunction occured.No patients had deteriorative symptoms and signs.Conclusion It is the crucial factors to a successful operation by adopting complete depcomression and intervertebral fusion and solid internal fixation for treatment of lumbar spondylolisthesis.