重度腰椎滑脱症的手术治疗

Surgical Treatment of Lumber Spondylolisthesis Over Meyerding Grade-Ⅲ

目的探讨重度腰椎滑脱症的病理特点与手术方法。方法对18例重度腰椎滑脱症患者采用后路减压复位,椎弓根钉系统内固定加椎间植骨融合治疗,观察患者症状改善情况,滑脱矫正及植骨融合情况。结果经8～36个月随访,腰腿痛症状完全消失13例;滑脱椎体完全复位15例,大部分复位3例;达到完全骨性融合10例,无断钉断棒与拔钉等并发症发生。结论重度腰椎滑脱症大多由峡部崩裂引起,病史长、病理及解剖结构特殊。复位减压结合椎弓根钉系统加椎间植骨融合是治疗重度腰椎滑脱症的较好方法。准确置钉及二次彻底减压是手术成功的关键。

Objective To investigate the pathological features and surgical methods for spondylolisthesis more than Meyerding grade-III.Methods Decompression,reduction lumber interbody,fusion and fixation with pedicle screw system through posterior approach were performed in 18 patients,who sustained spondylolisthesis over Meyerding grade-III.In the group,there were 12 males and 6 females,and the average age of the patients was 48 years with a range of 35 to 61 years.Postoperative outcome including symptoms relief,positioning and union were evaluated.Results The mean follow-up was 21 months（range,8 to 36 months）.Thirteen of the patients did not complain of low back pain or leg radicular pain.Anatomical replacement was achieved in 15 of them.Complete reposition was nearly achieved in the other 3 after operation.Bony fusion was found in 10 of them.The other 8 were followed.No rod or lag screw disrupted.None of pedicle screws was displacement.Conclusion Most spondylisthesis over Meyerding grade-III results from defect within the pars interarticularis.Retroposition,decompression,fusion and immobility with pedicle screw system is an ideal alternative for spondylolisthesis more than Meyerding grade-III.Accurate insertion of lag screw and decompression thoroughly are critical for a successful procedure.