应用椎弓根复位固定系统与椎间融合器改善腰椎滑脱患者椎间隙高度的观察

Transpedical reduction fixation system and threaded fusion cage for improving intervertebral height of patients with lumbar spondylolishtesis

目的探讨椎弓根复位固定系统与螺纹状椎间融合器(threadedfusioncage,TFC)联合应用治疗腰椎滑脱的疗效。方法临床按以上术式共治疗成人腰椎滑脱病例38例,术后进行腰背肌功能锻炼、理疗等康复治疗,对JOA评分好转率、滑脱率、椎间隙高度、植骨融合率等进行疗效评价。结果治疗病例平均随访10.5个月,平均JOA评分好转率为81.5%,优良率86.8%,术前滑脱率(38.8±9.7)%,术后滑脱率(9.4±4.0)%,最终随访时滑脱率(9.1±3.9)%,术后与术前比差异有显著性意义(t=21.7,P<0.01)。术前平均椎间隙高度(5.1±0.9)mm,术后为(9.8±1.0)mm,最终随访时为(9.3±0.9)mm,术后与术前比差异有显著性意义(t=32.7,P<0.01),植骨融合率为100%,无内置物断裂、移位情况。结论该术式能充分进行椎管减压、神经根松解、椎体间复位,固定较牢固,融合率较高,并发症较少,是目前比较理想的治疗成人腰椎滑脱的方法。康复治疗对减轻患者术后腰痛及减少神经症状复发有重要作用。

AIM:To explore the therapeutic effect of posterior transpedical reduction fixation system combined with threaded fusion cage (TFC) on lumbar spondylolisthesis. METHODS:Thirty eight lumbar spondylolisthesis patients were treated with this operation, and rehabilitative treatment was performed including functional training on muscle of back and waist and physiotherapy after operation. The rate of improved JOA score, spondylolisthesis rate, intervertebral height and fusion rate were evaluated. RESULTS:The treated patients were followed up meanly for 10.5 months. The rate of improved JOA score was 81.5%, the excellent rate was 86.8%.The spondylolisthesis rate of pre operation was(38.8±9.7)%,that of post operation was(9.4±4.0)%, and the final spondylolisthesis rate was(9.1±3.9)%.There was a significant difference between pre operation and post operation(t=21.7,P< 0.01).The intervertebral height of pre operation was(5.1±0.9)mm,that of post operation was (9.8±1.0)mm,and the final intervertebral height was(9.3±0.9)mm. There was a significant difference between pre operation and post operation (t=32.7,P< 0.01). The fusion rate was 100%without breakage of the intermaterial and displacement.CONCLUSION:This operation method can decrease the pressure of spinal canal, achieve a neural decompression and spinal reduction.It can fix the spine hardly and have a high fusion rate but with few complications.Nowadays it is a reasonable operative method to treat lumbar spondylolisthesis. Rehabilitative treatment can reduce lower back pain and decrease recurrence of neural symptoms.