椎弓根钉内固定系统治疗腰椎滑脱术后疗效影响因素

Discussion of related factors of influencing therapeutic effect in the operative treatment of the lumbar spondylolisthesis with the pedicle screw fixation

目的总结椎弓根钉内固定治疗腰椎滑脱的临床结果,分析影响术后疗效的相关因素,探讨有效的防范措施。方法回顾分析58例腰椎滑脱症患者行椎弓根钉内固定及植骨术后的资料。47例采用椎板开窗减压,椎弓根钉内固定,横突间及小关节突间植骨融合术。11例采用全椎板减压,椎弓根钉内固定和后路椎间、横突间植骨融合。对术后疗效相关因素进行分析。结果58例均获得随访,时间14-63个月。临床疗效按照邹德威综合评价标准：优47例,良5例,一般2例,差4例,优良率达89.6%。疗效不佳主要为：1例椎管减压不彻底,2例为滑脱椎体复位过度,3例为植骨未融合,其中2例滑脱复发。结论椎弓根钉内固定系统治疗腰椎滑脱症是有效的方法。彻底的减压,有限复位滑脱的椎体,有效的椎间、横突间植骨融合,术后腰骶部支具外固定是影响患者术后疗效的主要因素。

Objective To evaluate the result of operative treatment of lumbar spondylolisthesis with the pedicle screw fixation and analyze its related factors of influencing the postoperative therapeutic effect and provide effective preventional measures. Methods Totally 58 cases of lumbar spondylolisthesis were operated with the pedicle screw fixation. The 47 patients were treated with semi-laminectomy decompression, pedicle screw fixation and intertransverse process fusion. The 11 patients were performed with full-laminectomy decompression, pedicle screw fixation and posterior interbody and/or intertransverse process fusion with autologous and/or allograft bone grafts. Therapeutic effect and its related factors were analyzed. Results The 58 cases were followed up for 14 - 63 months. The clinical results were assessed according to the evaluation criterion of Zou De-wei. The outcomes were excellent in 47 cases, good in 5, fair in 2 and poor in 4. The excellent and good rate was 89. 6%. The main reasons of the poor clinical result included deficient decompression of posterior lumbar spinal canal in 1 case, over-reduced spondylolisthesis vertebra in 2 cases,poor grafting bony fusion in 3 cases and the relapse of spondylolisthesis in 2 cases. Conclusions The surgical operation is very effective methods for treating lumbar spondylolisthesis with the pedicle screw fixation. The complete decompression, the related reduction, the efficient posterior interbody and/or posterolateral bone grafting and correct external fixation with lumbosacral protective brace are the significant measures for good postoperative therapeutic effect in the treatment of lumbar spondylolisthesis.