椎体间撑开复位短节段固定治疗Ⅱ度及以上峡部型腰椎滑脱症

Treatment of degree Ⅱ and above lumbar isthmic spondylolisthesis with podyrtion lumbar interbody fusion distraction between intervertebral bodys and supplemental instrumentation

目的:探讨椎体间撑开有限复位辅以短节段内固定治疗Ⅱ度及以上峡部型腰椎滑脱症的手术方法,观察其临床效果。方法:采用斜向单枚椎间融合器行椎体间撑开有限复位,再辅以椎弓根螺钉系统短节段固定治疗19例Ⅱ度及以上峡部型腰椎滑脱症,随访12￣36个月,定期摄X线片,观察其融合率,了解其治疗效果。结果:所有病例均在术后12￣18个月获得骨性融合。滑脱复位情况:17例术后滑移程度小于10%,2例小于20%。临床效果评价:优11例,良8例。结论:通过对19例Ⅱ度及以上峡部型腰椎滑脱症行外科手术治疗,在彻底的神经根、硬膜囊减压基础上的椎体间撑开,有限复位并获得可靠的融合,通过辅以短节段内固定,恢复了腰椎良好力线,取得了满意的治疗效果。

Objective：To observe the results of degree Ⅱ and above lumbar isthmie spondylolisthesis treated with podyrtion lumbar interbody fusion distraction between intervertebral bodys and supplemental instrumentation.Methods：Nineteen patients with degree Ⅱ and above lumbar isthmic spondylolisthesis underwent a posterior lumbar interbody fusion,using single fusion cage inserted posterolaterally and oriented anterolateraUy on the symplomatic side,and with same level underwent transpedicular screw rod fixation.The patients （26 to 50 years of age,average 40 years of age） had at least one year of low back pain and/or sciatica, and a severely restricted functional ability.The patients were followed up for 12 to 36 months,The stability and fusion of the disorder segments were observed on the X-ray film. Results：All these 19 patients achieved successful radiographic fusion at 12 to 18 months.Clinically, 11/19 patients were excellent, 8/19 patients were good, No implant fractures or deformities occurred in all patients. Conclusion：The aim of surgical treatment of isthmic spondylolisthesis is said interbody fusion on the basis of adequate decompression of the neurological structures, and appropriate lumbar lordortic alignment and limted reduction through distraction of the interbody space using diagonal insertion of single threaded cage with supplemental transpedicular screw rod instrumentatoin.The clinical effect of the treatment is excellent.