经后路椎体间植骨融合椎弓根螺钉内固定治疗退行性腰椎滑脱症

Treatment of Degenerative Lumbar Spondylolisthesis With Posterior Lumbar Interbody Fusion(PLIF) Combined With Pedicle Screw Fixtation

目的探讨经后路减压、椎间植骨融合加椎弓根螺钉内固定治疗退行性腰椎滑脱症的临床疗效。方法本组患者35例，平均年龄59岁（49-68岁）。所有患者均行腰椎正侧位、动力位片和MRI或CI’检查。本组患者均为退变性腰椎滑脱症。滑移分度：Ⅰ°19例，Ⅱ°14例，Ⅲ°2例，其中L5/S1 27例，L4/5 8例。均表现为下腰痛，间歇性跛行或坐骨神经症状。35例全部采用后路去椎板减压、椎间融合器（Cage）植骨，椎弓根螺钉内固定术，并进行术前、术后功能和症状评分。结果随访12-35个月，平均23个月，依据x线片和临床症状恢复情况，本组患者均获骨性融合，JOA评分术前平均16．25±1．06分，术后平均24．78±1．27分，两者差异有显著性（P〈0．01），优良率94．3％。结论后路减压、椎间融合器植骨加椎弓根螺钉内固定是治疗退行性腰椎滑脱症的一种安全有效的方法，临床疗效满意。

Objective To evaluate the effectiveness of posterior lumbar decompression with posterior lumbar interbody fusion and pedicle screw fixtafion in patients with degenerative lumbar spondylolisthesis. Methods 35 patients of degenerative lumbar spondylolisthesis were studied. The mean age at the time of operation was 59 years. All cases were treated with X-ray and MRI/CT. Spondylolisthesis degree： Ⅰ°19,Ⅱ°14 and Ⅲ°2cases. The involved segments were L5/Slin 27cases, L4/L5 in 8 cases. All cases showed off below lumbar, painintennittent limping or sciatic nerve pain, and were treated with canal decompression and pedicle screw fixtation combined with cage interbody fusion. Results The follow---up period was 12 to 35 months. The Japanese Orthopedic Association （JOA） score increased from 16.25±1.06 points before the operation to 24.78±1.27points at the time of the study on average. The general improvement rate was 94.3 %. Conclusion The surgical technique of canal decompression and pedicle screw fixtation combined with cage interbody fusion is an effective method for treatment of degenerative lumbar spondylolisthesis.