椎弓根螺钉加椎间植骨融合器治疗腰椎滑脱症的远期疗效分析

Long-term outcome of posterior reduction and lumbar interbody fusion in isthmic spondylolisthesis

目的:探讨椎弓根螺钉系统加椎间植骨融合器(cage)治疗峡部不连性腰椎滑脱症的远期疗效。方法:1996年10月～2002年1月收治的峡部不连性腰椎滑脱症患者中资料齐全的82例,均在椎弓根螺钉系统作滑脱复位后加cage行椎间融合固定。58例为1枚cage从后斜向前呈45°置入,24例为2枚cage从后向前垂直置入。随访时观察固定节段的椎体间有无位移、滑脱有否复发,测量术前、术后2周及随访时固定椎间隙的高度与近心端第二椎间隙高度比值的变化。结果:随访24～86个月,平均36个月。根据Nakai评分标准,优良率为79.3%。19例Ⅰ度腰椎滑脱患者术后全部解剖复位;47例Ⅱ度滑脱患者5例留有Ⅰ度滑脱;16例Ⅲ度滑脱患者4例留有Ⅰ度滑脱。至随访时,使用1枚cage或2枚cage所固定的椎间隙高度与近心端第二椎间隙高度的比值较术后2周时的比值减低,但统计学上无显著性差异,滑脱无复发。结论:使用椎弓根螺钉加cage治疗腰椎滑脱症可减少术后折钉和滑脱复发的问题,是治疗腰椎滑脱症比较理想的手术方式。1枚cage即可以达到稳定椎间的作用。

Objective：To investigate the long-term outcome of posterior reduction and lumbar interbody fusion in isthmic spondylolisthesis,Methocl：82 consecutive patients with broken isthmic spondylolisthesis were restrospected from October 1996 to January 2002,they were all treated surgically with pedicle screw system and cage.One cage was placed in lumbar interbody at an angle of 45° anteriorposteriorly in 58 cases（group 1）,and two cages were placed vertically in the other 24 cases （group 2）.The height of interbody and the upper adjacent interbody＇s height was noted preoperatively,2 weeks postoperatively and follow-up period respectively.Resuit：The follow-up period was 24-86 months,averaged 36 months.The excellent and good rates were 79.3 percent,according to Nakai criterion. 19 patients with one degree spondylolisthesis were all reduced anatomically after surgery.47 patients with two degree spondylolisthesis were reduced anatomically except for 5 patients with one degree residual spondylolisthesis. 16 patients with three degree spondylolisthesis were reduced anatomically except for 4 patients with one degree residual spondylolisthesis.There were slight loss of interbodies height at later follow-up period compared with 2 weeks postoperatively in two groups which had no statistical significance.Conclusion：Lumbar spondylolisthesis treated surgically with pedicle screw system and cage may decrease the rate of complications such as instrument failure and spondylolisthesis recurrence postoperatively.One cage is enough to support segment,which can treat lumbar spondylolisthesis effectively.