退变性腰椎滑脱手术治疗118例报告

SURGICAL TREATMENT FOR DEGENERATIVE SPONDYLOLISTHESIS IN 118 CASES

目的观察退变性腰椎滑脱使用内固定复位后的临床疗效。方法1998年3月～2003年3月手术治疗退变性腰椎滑脱患者135例，其中获得随访118例。按是否行内固定把患者分为两组，Ⅰ组仅行椎板减压，后外侧植骨融合，未行内固定治疗，共67例；Ⅱ组减压同时行短节段椎弓根内固定治疗，共51例。Ⅰ组患者年龄55．75（43～71）岁，滑脱节段L35例，L434例，L528例。Ⅱ组患者年龄52．45（41～68）岁，滑脱节段L33例，L426例，L522例。术后定期随访，行DR检查，观察其滑脱程度、椎间盘高度变化，矢状面Cobb角的变化，采用SPSS 11．5统计软件处理数据。结果术后随访时间1．5～8年，平均3．4年。临床优良率（87％、85％）无显著性差异（P〉0．05）。Ⅰ组术后无固定螺钉松动、断裂及滑脱加重，椎间融合器无明显移位，均达骨性愈合。Ⅱ组有4例腰椎滑脱处假关节形成。两组神经损伤发生率、再手术返修率、术后滑脱加重程度、矢状面Cobb角变化无显著性差异；手术操作时间、手术出血量、术后椎间盘高度丢失内固定组明显高于非内固定组。结论退变性腰椎滑脱进行减压、植骨的同时不一定必须进行内固定，增加内固定虽然可以增加脊柱的稳定性，提高骨融合率，但是术后邻近节段椎间盘高度易丢失。

Objective To observe the clinical outcomes of the degenerative spondylolisthesis treated with pedicle screw fixation systems. Methods One hundread and eighteen patients who had suffered from degenerative spondylolisthesis were studied. From Mar. 1993-Mar. 2003, group Ⅰincluded 67 patients underwent only posterior decompression while that in group Ⅱ where 51 cases with laminectomy and short segmental pedicle fixation（group Ⅱ ）. Recovery rate, operation time, quantity of hemorrhage, reoperation rate, incidence of never injury, the severity of spondylolisthesis, the height of the disc, Cobb＇s angles change were compared respectively. In groupⅠ ,the patients were 41-68 years old,with an average of 55.75 years old. In group Ⅱ the patients were 41-68 years old with an average of 52.45. In group Ⅰ ,the location of the disease lies in L3 5, L4 34, L5 28 and in group Ⅱ L3 3 cases, L4 26 cases, L5 22 cases. Results Clinical outcome was excellent or good in 85% of the patients with instrumentation placement and in 87 % of those without instrumentation placement（ P 〉0.05）. Patients in whom instrumentation was placed have an longer operation time （ P 〈0.01） and larger quantity of hemorrhage（ P〈 0.01）. But the reoperation rate and incidence of nerve injury have no significant difference between two groups. Conclusion It is not necessary to perform internal fixation while the decompression of the canal and bone transplant. It is useful to stength the stability of the spine and increase the bone fusion rates, but it is not useful to keep the disc height of the adjacent disc.