后路环状融合术在腰椎滑脱症外科手术中的应用

Application of posterior circumferential fusion in the surgery of lumbar spondylolisthesis

[目的]探讨后路环状融合术（PCF）联合短节段椎弓根螺钉系统内固定治疗腰椎滑脱症（LSL）的可行性、方法及临床疗效。[方法]从2002年10月～2006年3月，对44例LSL患者采用腰椎管减压、环状植骨融合及短节段椎弓根螺钉内固定手术进行治疗。男15例，女29例；年龄31～68岁，平均48．6岁。所有患者术前均经X线和CT证实为腰椎滑脱合并椎管狭窄。按Newman分型：退变性滑脱15例，峡部裂性滑脱29例。按Meyerding分级：Ⅰ度滑脱17例，Ⅱ度滑脱24例，Ⅲ度滑脱3例。L4、5滑脱18例，L5S1滑脱26例。[结果]全部病例随访18～36个月，平均26个月。17例Ⅰ度滑脱术后全部解剖复位；24例Ⅱ度滑脱中6例遗留Ⅰ度滑脱；3例Ⅲ度滑脱中2例遗留Ⅰ度滑脱。根据侯树勋临床疗效评价标准，优28例，良13例，可3例，优良率达93．2％。无内固定松动断裂和神经根与马尾神经损伤并发症。术后3～10个月植骨均获骨性愈合，平均4．2个月。随访期间椎间隙高度维持良好，滑脱椎体复位无丢失。[结论]PCF联合短节段椎弓根螺钉系统内固定是治疗LSL的一种可靠方法，能够提高脊柱的融合率并维持良好的椎间隙高度和形态及腰椎生理性前凸。满意的临床效果依赖于全面掌握PCF和短节段椎弓根螺钉固定的技术特点。

[ Objective ] To evaluate the feasibilitiy, methods and therapeautical effects of the posterior circumferential fusion （PCF） combined with short - segmental pedicle screw system fixation for the treatment of lumbar spondylolisthesis （LSL） . [Method] From October 2002 to March 2006, 44 cases of LSL were treated with decompression for spine canal stenosis, circumferential fusion and short - segmental pedicle screw system fixation. There were 15 male and 29 female, average age was 48. 6 （ranged, 31 -68） years. The diagnoses of LSL and stenosis were confirmed by X - ray and CT. According to Newman classification, 15 of them were the degenerative type and 29 were isthmic type. According to Meryerding classification of LSL, 17 patients had degree Ⅰ, 24 patients had degree Ⅱ and 3 patients had degree Ⅲ spondylolisthesis. The levels of LSL was between L4 and L5, in 18 patients and between L5 and S1 in 26 cases. [ Result] The follow - up period was 18 -36 months , averaged 26 months. Seventeen patients with degree Ⅰ spondylolisthesis were all reduced anatomically after surgery. Twenty - four patients with degree Ⅱ spondylolisthesis were reduced anatomically except for 6 patients with Ⅰ degree residual spondylolisthesis. 3 patients with degree Ⅲ spoadylolisthesis were reduced anatomically except for 2 spatients with Ⅰ degree residual spondylolishesis. The effect was evaluated according to Hou Shuxun＇s evaluation standard, the results were excellent in 28 cases, good in 13 cases, and fair in 3 cases. The excellent and good rate was 93.2%. No complication such as interfixation failure and nerve pedicle injury or canda equine injury were found. All cases got bony union in 3 to 10 months （ mean 4. 2 months） postoperatively. All patients had normal disc height and no loss of spondylolisthesis reduction. [Conclusion ] The PCF combined with short - segmental pedicle screw system fixation is reasonable options in treating the LSL It can improve the fusion rate of the spine and maintain good intervertebral space and good lordosis of the lumbar spine. The satisfactory clinical result is relied on the completely understanding of the characteristics of PCF and short - segmental pedicle screw fixation.