改良经后路椎体间融合术治疗腰椎滑脱症

Modified Posterior Lumbar Interbody Fusion for Lumbar Spondylolisthesis

目的探讨单枚Cage加自体骨块椎间融合的改良经后路椎体间融合(PLIF)治疗腰椎滑脱症的疗效。方法自2000年12月～2006年6月,笔者在椎弓根螺钉系统复位固定的基础上用1枚Cage加1块自体骨椎间融合的手术方法治疗腰椎滑脱症46例,崩裂性滑脱24例,退变性滑脱22例。其中男25例,女21例;年龄29～67岁。部位:L3、42例,L4、523例,L5S121例。根据Meyerding滑移分度法:Ⅰ度22例,Ⅱ度19例,Ⅲ度5例。结果随访8～72个月,平均25个月。根据Nakai疗效评定标准:优23例,良22例,可1例。术后滑脱复位44例,Ⅲ度恢复到Ⅰ度2例。结论Cage加自体骨块融合的改良PLIF手术治疗腰椎滑脱症,具有固定坚强、较好维持椎间高度、良好的椎间骨融合、疗效确实等优点。

Objective To explore the clinical effect of posterior pedicle screw reduction and lumbar interbody fusion using one cage and one mass of autogenus bone grafting for treatment of lumbar spondylolisthesis. Methods From December 2000 to June 2006, forty- six patients with lumbar spondylolisthesis including 25 males and 21 famales, aged between 29 and 67 years old were treated by posterior pedicle screw reduction and lumbar interbody fusion using one cage and one mass of autogenus bone grafting. Twenty - two patients had degenerative lumbar spondylolisthesis and 24 had broken isthmie lumbar spondylolisthesis. Spondylolisthesis was located at L3,4 in 2 patients, L4,s in 23 and L5S1 in 21. According to Meyerding method, there was degree Ⅰ in 22 patients, degree Ⅱ in 19 and degree in 5. Results The follow up period ranged from 8 to 72 months, 25 months on average. According to Nakai criterion, 23 patients were excellent, 22 good and 1 fair. Twenty- two patients with degree Ⅰ and 19 with degree Ⅱ lumbar spondylolisthesis were reduced anatomically. Five patients with degree Ⅲ lumbar spondylolisthesis were reduced anatomically except 2 patients with degree Ⅰ residual lumbar spondylolisthesis. Conclusion The modified posterior lumbar interbody fusion can facilitate intervertebral body fusion, and keep the height of intervertebral space, with the advantages such as more stability for treatment of lumbar spondylolisthesis.