无内固定前路手术治疗腰椎滑脱症

Treatment of lumbar spondylolisthesis with anterior route operation without internal fixation

目的探讨不加任何内固定手术治疗峡部裂性腰椎滑脱的可行性,评估复位率、融合率以及疗效,以帮助无能力支付内固定物费用的患者。方法选择Meyerding法Ⅱ°以内的峡部裂腰椎滑脱症36例,经前路腹膜外减压、复位,21例自体髂骨块2块,15例深低温异体骨圈复合自体松质骨,做椎体间嵌植融合,术后离床活动,支具外固定3～6个月。结果35例随访1～10年,复位率Ⅱ°者>50%,Ⅰ°者超过85%。除1例骨块向前移位吸收需二期手术外,余34例获得骨性融合,融合率97.1%,优良率94.3%,每例节省费用2～3万元。结论无内固定前路手术可以安全、可靠治疗Ⅰ～Ⅱ°峡部裂性腰椎滑脱症。

Objective: To discuss the feasibility of treating lumbar spondylolisthesis with anterior route operation without internal fixation, evaluate the reduction rate,fusion rate and clinical outcome. Method:Thirty-six cases with I° or II° lumbar spondylolisthesis were treated with anterior route decompression,reduction,21 cases used autograft and 15 cases used allograft for anterior lumbar intervertebral fusion. All cases wore a cast postoperation for 3～6 months. Result:Thirty-five cases were followed up for 1～10 years. The reduction rate of grade Ⅰ patients were over 85%,when over 50% in grade Ⅱ patients.34 cases gained bony fusion except 1 case had graft migration and needed revision. The fusion rate was 97.1%.Conclusion: Anterior route operation without internal fixtion is a safe and effective option for treating lumbar spondylolisthesis.