不同手术方式治疗腰椎滑脱症的比较

A comparative study of the different surgical technique for lumbar spondylolisthesis

目的:比较采用不同内固定及植骨融合方式治疗腰椎滑脱症的手术疗效及适应证。方法:应用后路椎弓根螺钉复位内固定后,分别采用后外侧植骨融合术、后路椎体间植骨融合术及前路椎体间植骨融合术治疗不同类型及合并症的腰椎滑脱症患者67例,比较不同术式的手术时间与出血量、手术疗效与并发症、滑脱椎体复位率与复位丢失率以及椎间隙高度。结果:后路椎弓根钉固定加椎体间植骨融合术手术时间最长、出血量最多;手术总体优良率为88.71%,三种术式间无差异。所有椎体间植骨组植骨融合良好,椎间隙高度维持良好,滑脱椎体复位无丢失;12例后外侧植骨者平均复位丢失率为11.24%,2例椎弓根螺钉松动,2枚椎弓根螺钉断裂。结论:退变性腰椎滑脱者宜选用后路椎弓根钉固定加后外侧植骨融合术;峡部裂性腰椎滑脱者宜选用后路椎弓根钉固定加椎体间植骨融合术;腰椎滑脱翻修者宜选用后路椎弓根钉固定加前路椎体间植骨融合术。

Objective: To investigate the ideal surgical technique for the different types of lumbar spondylolisthesis and indication.Method:67 patients with different types of lumbar spondylolisthesis and complications were treated with posterior pedicle screw fixation and different bone graft fusion technique from Feb.2000 to Dec.2003.The operative time and amount of bleeding,therapeutical effect,rate of lumbar spondylolithesis reduction and loss of reduction,bone graft fusion and disc height were observed.Result:The operative time and amount of bleeding were most in the technique of posterior pedicle screw fixation and lumbar interbody fusion.The whole follow up excellent and good rates were 88.71 per cent.There was no difference among three techniques.22 patients with one degree lumbar spondylolisthesis and 32 patients with two degree lumbar spondylolisthesis were reduced anatomically,and 9 patients with two degree lumbar spondylolisthesis and 4 patients with three degree lumbar spondylolisthesis were reduced to one degree.All patients with lumbar interbody bone graft had good fusion,normal disc height and no loss of spondylolisthesis reduction.12 patients with simple posterior lateral bone graft fusion had loss of spondylolisthesis reduction to a certain extent.Two pedicle screws were loosed and two pedicle screws were broken.Conclusion:The patient with degenerative lumbar spondylolisthesis should be treated with posterior pedicle screw fixation and posterior lateral bone graft fusion,the patient with severe lumbar broken isthmus spondylolisthesis should be treated with posterior pedicle screw fixation and lumbar interbody fusion,the revision should be treated with posterior pedicle screw fixation and anterior lumbar interbody fusion.