后路椎弓根固定270°椎间融合治疗腰椎滑脱

Treatment of Lumbar Isthmus Spondylolisthesis with Vertebral Arch Screw Fixation and Posterior Lumbar Interbody Fusion with 270 Angle

目的探讨经后路单侧后外侧融合基础上，单枚BAKcage斜向置人或后路椎体间植骨融合的270°融合治疗峡部裂型腰椎滑脱症的临床疗效。方法2004年8月至2007年8月，对19例峡部裂型腰椎滑脱按Meyerding分度，Ⅰ度滑脱12例，Ⅱ度滑脱7例，分别采用椎弓根螺钉复位固定单侧后外侧融合并单枚cage椎体间融合（A组）或椎弓根螺钉复位固定单侧后外侧融合并椎体间植骨融合（B组）两种270。融合方法治疗。结果19例病人术后随访时间12～24个月，平均18个月。joA评分总体满意率为95％，其中A组为100％，B组为91．7％，两者无显著性差异。19例病人均完全复位，随访复位无明显丢失。所有病人均无内固定松动断裂、cage明显后移沉降和神经根及马尾损伤等并发症。全部病人术后1年随访均获得骨性愈合。最终随访椎间隙高度平均减少1．2mm，B组较A组明显。结论两种后路270。植骨融合方式加椎弓根螺钉复位固定治疗峡部裂型腰椎滑脱对后柱破坏少，具有较高稳定性，均能获得满意疗效并能明显降低内固定松动断裂和复位丢失率，提高脊柱融合率。

Objective To compare the outcome ot lumbar isthmus spondytolisthesis treated with verteoral arcn screw reduction-fixation,posterior lumbar interbody fusion （PLIF） with mono-eage or treated with posterior lumbar interbody fusion by bone graft. Methods From Aug 2004 to Aug 2007,19 cases of grade Ⅰ or Ⅱ lumbar isthmus spondylolisthesis were treated with vertebral arch screw reduction-fixation,mono-posterolateral fusion. Among them 7 cases were treated with posterior lumbar interbody fusion（PLIF）by mono-cage（groupA） and 12 cases were treated with posterior lumbar interbody fusion by bone graft（group B）. Results 19 cases were followed-up at a mean time of 18 months （range 12 to 24 months）post-operation. The excellent and good result rate of JOA score in group A and B was 100% and 91.7 % respectively,there were no significant difference in the JOA score between two groups. The total excellent-good result rate and fusion rate was 95% and 100% respectively. No screw breakage or internal fixation loosening were found and no loss of spondylolisthesis reduction or nerve root and cauda equine injury were found postoperation. Cage position retrusion and subsidence were not found either. At the last follow-up ,the average loss of intervertebral height was 1.2 mm and group B was more severe than group A. Conclusion Two methods of posterior lumbar interbody fusion with 270 angle are very effective to lumbar isthmus spondylolisthesis and can provide good stability with minimal damage. It can also improve the fusion rate ,decrease internal fixation loosening and loss of reduction.