合并骶骨裂的腰椎椎弓峡部裂的手术治疗策略

Treatment of lumbar spondylolisthesis with spinal bifida occulta

[目的]探讨合并骶骨裂的腰椎椎弓峡部裂手术治疗原则。[方法]回顾性研究一组合并骶骨裂的腰椎椎弓峡部裂病人共26例,男性19例,女性7例;平均年龄23.2岁。所有病人均经过X线、CT、MRI检查,并在此基础上将椎间盘退变分为5级,椎体滑移4度分级,并且提出骶骨裂新的分型方法:A型骶骨椎板单侧发育不良,但与棘突仍有相连,仅仅为椎板之间有裂隙;B型骶骨双侧板均发育不良,棘突呈游离状态;C型骶骨椎板完全缺如,棘突缺如;D型骶骨裂合并其他畸形,如骶骨终板钩状、L5横突畸形、腰椎裂。[结果]本组手术方式包括单椎节固定9例,单节段固定13例,2节段固定4例。随访26例,随访时间6～37个月,平均11.2个月,随访疗效结果:优8例,良13例,可5例,差0例。[结论]对于腰椎峡部裂合并骶骨裂病人手术选择的问题,建议应注意骶骨裂的分型、腰椎峡部裂的滑移程度及椎间盘退变情况。

[ Objective] To approach the treatment principle of lumbar spondylolisthesis with spina bifida occuha. [ Methods] Twenty-six patients （malel9, female 7, average 23.2 years old） with spondylolisthesis and spina bifida occuha were analyzed retrospectively. All cases were evaluated by radiological examinations including X-rays, computed tomography, magnetic resonance image. Based on the radiological results, the degeneration of intervertebual disc were varied by Ⅰ - Ⅴ types. Meyerdin＇s score was used to evaluate the severe slip of the body of spondylolysis. At same time spina bifida occuha was di- vided into 4 models as follows, type A meant that the semi-lamina of sacrum was hypoplasia and still linked with spinous process ; type B meant that the both sides of the lamina of sacrum was hypoplasia and the spinous process was free ; type C meant that the lamina of sacrum was absent ; type D meant that the spina bifida occuha was companied by other deformities such as the round formation of the end-plate of sacrum, the deformity of the transverse process of L5. [ Results ] The modality of the operations included 9 cases in single-vertabra fixation, 13 cases in single-segment fixation, 4 cases in two-segment fixation. All patients had been follow-up for 6 - 37 months （ average 11.2 months）. The effect of treatment was also obtained （ 8 in excel- lent, 13 in good, 5 in fair）. [Conclusions] As for how to do with spendylolisthesis with spina bifida occuha （SBO）, the type of SBO, degeneration scores of the disc and the degree of the slip of spondylolysis should be taken into consideration.