经后路椎间植骨治疗下腰椎滑脱

Using Posterior Interverbral Graft Bone Fusion to Treat Lower Spondylolisthesis

目的、观察经后路椎体间和椎板、横突间植骨融合术治疗腰椎滑脱，对比两种不同植骨融合的近远期效果。方法腰椎滑脱有手术指征患者．据CT判断椎管内马尾及神经根受压情况及平卧位后有无神经症状分为两组，A组14例，CT示椎管内硬脊膜囊及神经根受压明显及平卧位后神经症状部分消失，采用经后路椎管开窗减压及椎体间植骨融合术；B组20例，CT示椎管内硬脊膜囊及神经根受压不明显及平卧位后神经症状基本消失，采用椎板间或横突间植骨，以上患者均结合椎弓根内固定系统固定。结果随访时间1～2年，4～6个月椎体融合，无椎弓根螺钉松动、断裂，无椎体间植骨脱落至椎管内．腰、下肢疼痛明显缓解及下肢肌力、感觉均有恢复，4～6个月后均能恢复日常生活及极轻体力工作。取得较满意疗效。结论椎体间和椎板、横突间植骨融合率和融合时间及术中平均输血量无明显差异，功能恢复无显著差异．A组植骨所需量少于B组。

Objective To observe the treatment effects of the surgery for lumbar spondylolisthesis by posterior intervertebral （anterior column）（PLIF surgery）, intervertebral plates, intertransverse process graft bone fusion. Compare the effects between the two kinds of graft fusion in the short term and long term. Methods We divide the lumbar spondylolisthy patients who have the surgical indications into 2 groups according to the results of the computerized tomography. Group A.. cauda eguina nerval symptoms disappear partly at prostration. They are treated by Posterior spinal canal decompression by fenestration and intervertebral graft bone fusion （PLIF surgery）. Group B： In 20 cases, we see that dura maters and nerve roots are slightly compressed and the nerval symptoms disappears nearly at prostration. They are treated by intervertebral plates, intertransverse process graft bone fusions. Those above 2 groups are also treated together with internal fixation system of spinal pedicles. Results Follow-up study of the patients range from 1 to 2 years. The vertebra fuses from 4 to 6 months without loosening or collapsing screws, and no bone fragments fall into vertebral canal. The pain of the lumbar part and lower limb relieves significantly while muscle force and sense recovers. Patients can adapt to daily life and slight physical labor. The curative effect issatisfactory. Conclusion There is no significant difference between the two groups of the mount of blood transfusion, time and function recovery of the surgery of posterior intervertebral, （anterior column）（PLIF surgery）, intervertebral plates and intertransverse process graft bone fusion. The mount of the bone for graft of group A is less than that of the group B.