腰椎退行性多节段滑脱的手术治疗

Surgical treatment of multilevel lumbar degenerative spondylolisthesis

目的探讨腰椎退行性多节段滑脱的手术治疗方法。方法2005年3月至2008年9月，采用后路彻底减压、复位、椎弓根内螺钉固定360。融合治疗多节段腰椎滑脱患者25例。其中男性7例，女性18例；年龄38～75岁，平均56．6岁。滑脱均为退行性变化引起，类型有：前滑脱12例，后滑脱2例，混合滑脱11例。患者均行腰椎后路减压融合手术，术后随访6个月～4年，根据Lenke标准评价脊柱植骨融合情况，根据Henderson标准评价临床疗效。结果术后25例患者均获得完全复位。植骨融合结果：LenkeA级23例，B级2例；临床疗效Henderson评价结果：优16例，良6例，可3例。结论多节段腰椎退变滑脱发病机制和治疗方法与单节段腰椎滑脱不尽相同，后路彻底减压，适度复位，后外侧植骨融合结合椎间融合能获得较好的临床效果。多节段滑脱复位时应根据滑脱的类型选择不同方法。

Objective To discuss the surgical treatment of multilevel lumbar degenerative spondylolisthesis. Methods From March 2005 to September 2008, 25 cases of multilevel lumbar degenerative spondylolisthesis were treated with total laminectomy, reduction of spondylolisthesis and 360~ circumferential fusion through interbody （PLIF）, transverse process （PLF） and pedicle screw fixation. All cases were followed up for 0. 5-4 years. The Lenke grading system was used to assess the spinal fusion and Henderson grading system was used to assess the clinical outcomes. Results Complete reduction of spondylolisthesis was achieved in all cases. The bone fusion was grade A in 23 cases, grade B in 2 cases. The clinical outcome was excellent in 16 cases, good in 6 cases and poor in 3 cases. Conclusions The pathogenesis of lumbar degenerative multilevel spondylolisthesis is different from that of single-level spondylolisthesis. Complete decompression, reduction of spondylolisthesis sufficient fusion and reliable pedicle screw fixation can provide successful interbody fusion and satisfactory clinical results. It＇s crucial to reduce multilevel spondylolisthesis by proper techniques based on different types of listhesis.