经关节突入路手术治疗峡部裂性腰椎滑脱及康复

Nerve root decompression and intervertibral fusion with pedicle screw fixation through articular process approach and rehabilitation in the treatment of spondylolisthesis

目的:评价经关节突入路神经根管减压,椎间融合椎弓根固定手术治疗峡部裂性腰椎滑脱及手术前后康复治疗的综合疗效,并阐明该术式的适应证。方法:经关节突入路行椎间融合椎弓根系统固定治疗峡部裂性腰椎滑脱患者43例,随访40例,平均年龄58.2岁。患者选择标准为症状以腰痛伴腿痛为主,体征多表现为神经根受压,CT和MRI显示椎管内的压迫不明显,脊髓造影显示椎管大致通畅,滑脱节段的一侧或双侧神经根袖充盈欠佳。术前、术后均进行系统的康复训练。平均随访时间1.65年。结果:术后采用Stauffer—Coventry下腰椎术后疗效评定标准:临床优良率为87%,术后神经功能改善率为87.81%。术后无螺钉松动、断裂或者滑脱加重等并发症。结论:以神经根受压为主要表现的峡部裂性腰椎滑脱的患者,手术应选择经关节突入路神经根管减压椎间融合椎弓根固定,并术后进行系统的康复训练,具有良好的临床效果。

Objective：To evaluate the technique of the nerve root decompression and effect of intervertibral fusion with pedicle screw fixation through articular process approach for patients with nerve root compression and rehabilitation in lumbar broken isthmus spondylolisthesis.Metbod：40 cases aged 58.2 years were taken a follow-up of 1.65 years from 43 cases, who were referred to nerve root compression in lumbar broken isthmus spondylolisthesis, and treated with nerve root decompression and intervertibral fusion with pedicle screw fixation through articular pro- cess approach from September 2000 to May 2003, interbody Cages were used in all cases. The systematic rehabilitation therapy was conducted pre＇ and post＇operatively.Result：According to the evaluation of postoperative curative effect in low lumbar spine by Stauffer-Coventry, the clinical excellent and good rates was 87%, and the recovery rate was 87.81%. There was no complication such as screw loosen, broken or slippage, except pseudoarticulation formation in 1 case.Conclusion：The technique of nerve root decompression and intervertibral fusion with pedicle screw fixation through articular process approach combinated with systematic rehabilitation has a good result for patients with nerve root compression in lumbar broken isthmus spondylolisthesis.