腰椎滑移合并相邻节段症状性椎间盘突出的手术治疗

Surgical treatment of spondylolisthesis combined with symptomatic intervertebral disk herniation of consecutive segments

目的探讨腰椎滑移合并相邻节段症状性椎间盘突出的手术治疗方法，并对其疗效进行评估。方法对60例腰椎滑移合并相邻节段症状性椎间盘突出的患者采用后路椎体复位、椎间盘摘除、椎间植骨融合、椎弓根螺钉内固定术治疗，并进行术前、术后疗效评定和比较。结果术后3d内患肢或健肢酸痛、麻木者55例，术后3个月仍有患肢或健肢酸痛、麻木者9例，术后1年半仍稍有患肢酸痛者2例，其余患者术后随访2年以上均无明显下肢酸痛，但其中7例患者诉偶有腰背部酸痛。所有患者均于术后1年半左右获得椎间骨性融合，未出现椎弓根螺钉松动、断裂。术后1年Oswestry评分（26．07±9．36）分，与术前的（55．34±11．05）分比较差异有统计学意义（P〈0．05）。结论后路椎体复位、椎间盘摘除、椎间植骨融合、椎弓根螺钉内固定术是治疗腰椎滑移合并相邻节段症状性椎间盘突出的一种有效的手术方法，临床疗效满意。

Objective To investigate the surgical treatment of spondylolisthesis combined with symptomatic intervertebral disk hemiation of close together segments and evaluate the operative effect. Method From January 2001 to January 2009, 60 cases of spondylolisthesis combined with symptomatic intervertebral disk herniation of consecutive segments treated by posterior vertebral body reposition, excision of intervertebral disk herniation, interverbral implanted bone fusion and pedicle screw internal fixation, evaluated and compared the preoperative and postoperative effects. Results In 3 days postoperative, 55 cases had hemilateral or contralateral neuropathic pain or numbness, 9 cases had hemilateral or contralateral neuropathic pain or numbness 3 months postoperative, 2 cases had hemilateral neuropathic pain 1.5 years postoperative. Nobody had neuropathic pain after 2 years postoperative,but 7 cases had low back pain sometimes. The surface of the osteotomy infused after 1.5 years. There wasn＇t interplantation＇s clinch and breakage. Oswestry score 1 year postoperative average （26.07 ± 9.36） scores, preoperative average （55.34 ±11.05 ） scores, there was statistical significance between them （P 〈 0.05 ）. Conclusion Posterior vertebral body reposition, excision of intervertebral disk hermina, interverbral implanted bone fusion and pedicle screw internal fixation is an effective surgical method to treat spondylolisthesis combined with symptomatic intervertebral disk herniation of consecutive segments, it has satisfied clinical effect.