后路棘突椎间融合加内固定治疗腰椎滑脱与不稳

Treatment of lumbar spondylolisthesis with autograft spinous process interbody fusion and internal fixation

目的：探讨用整块自体脊柱棘突修整成短“T”形后椎间植入加内固定治疗腰椎滑脱与不稳症的临床疗效。方法：2005—04～2008—04，采用后路棘突椎间隙植骨融合及内固定治疗68例腰椎滑脱与椎体不稳症，观察其疗效。结果：滑脱椎体完全复位，所有椎间隙高度恢复正常。随访12～24个月，平均14个月，临床疗效评价：优52例，良15例，可1例。X线动态观察：全部病例均于术后3～4个月融合，无手术撑开的椎间隙高度回落丢失与再滑脱。结论：后路自体棘突椎间植骨加内固定治疗腰椎滑脱与不稳，能有效恢复和维持椎间隙高度，椎间融合速度快，融合率高，避免了用髂骨、异体骨或椎间融合器等带来的并发症。

Objective ： To investigate the clinical results of autograft spinous process interbody fusion and internal fixation for the treatment of the lumbar spondylolisthesis and unstable lumbar spine. Methods： From April 2005 to April 2008, 68 patients with lumbar spondylolisthesis and unstable lumbar spine were treated with autograft spinous process interbody fusion and internal fixation via the posterior approach, and the therapeutic efficacy was evaluated retrospectively. Results： All of the slipped vertebraes were reseated completely, and the height of intervertebral space was recovered. During an average follow - up period of 14 months （range, 12 -24 months）, 52 patients had excellent results, 15 good and 1 fair in clinical evaluation. All segments were confirmed to be fused by dynamic X -ray examination at 3 -4 months after operation, the height of intervertebral space was maintained at normal level, and the lumbar vertebraes were not slipped again. Conclusion： The combined spinous process interbody fusion and internal fixation in the treatment of lumbar spondylolisthesis and unstable lumbar spine has satisfactory reduction rate and excellent clinical result, avoiding some complications caused by implanting autogenetic iliac crest, allograft and metal cage.