局部自体骨移植在峡部裂性腰椎滑脱症中的应用

Clinical application of local autograft in adult lumbar isthmic spondylolisthesis

目的观察局部自体骨移植治疗峡部裂性腰椎滑脱症(Adult isthmic spondylolisthesis,AIS)的临床疗效。方法41例无明显骨质疏松的AIS患者,采用术中切除的滑脱椎棘突、椎板、关节突行椎间支撑植骨融合及非万向椎弓根螺钉系统固定,随访观察该组患者临床疗效。结果41例患者均采用四钉二棒的非万向螺钉系统行单节段融合(L3,42例,L4,523例,L5S116例);合并滑脱椎相邻节段椎间盘突出、椎间不稳定及椎管狭窄需行开窗减压神经根探查者均不予固定融合7例;手术时间2.5～3.5小时,出血量200～800ml,平均出血量320ml;术中置钉时发生钉道破裂3次,发生硬膜囊破裂3例,神经根袖破裂2例;33例随访3月至4年,平均2.3年,腰背痛明显减轻28例,腿痛减轻或消失16例,残余肢体麻木3例,足背伸肌力Ⅲ～Ⅳ级2例,腰椎疾患日本骨科学会(JOA)评分由术前(13.3±4.0)分恢复到末次随访时(26.6±3.3)分;X射线片示椎间植骨融合良好29例;滑脱复位有部分丢失3例,植骨块脱出于椎体后缘1例,钉棒系统断裂1例。结论局部自体骨移植结合非万向椎弓根螺钉系统牢固固定,取材和植入方便,来源丰富,是AIS患者椎间融合方法之一。

Objective To observate clinical effects using local self-lamina autograft in adult isthmic spondylolisthesis（AIS）. Methods 41 patients who had AIS without obvious osteoporosis were operated by local self-lamina autograft （inclued spinions,lamina and facet） harvested from slipping vertebrae and no-multioriention pedicel screw devices. Clinical results were followed up. Results A total of 41 patients were operated smoothly. Operation time was 2.5~3.5 hours and the arerage was 3 hours,and estimated blood loss were 200~800 ml,average 320 ml. 3 pedicle fracture taken place intraoperation 5 cases had CSF leak,33 patient were followed from 3 months to 4 years and average 2.3 years. Relief of lower back pain were observed in 28 cases,16 cases had relief of the lower leg and buttocks pain,calf numbness existed in 3 cases and dorsal foot hypesthesia were in 2 cases. The mean neurological score according to JOA improved from 13.4±4.0 before operation to 26.6±3.3 at last follow,good intervertebrae fusion had happened in 29 cases pyuedarthrosis was suspected in 2 cases. Partly loss of slipping vertebral reduction were in 2 cases,graft mass shifted to the posterior edge of the intervertesrial space in 1 case,screw-rod instrumention had loosened and broken in 2 case. Conculsion One of the good fusion way in PLIF for AIS is local autograft and rigid pedicle screw fixation because of convenience of harvesting and inserting fusion material.