椎弓根螺钉内固定并椎间Cage植骨治疗腰椎滑脱症

Treatment of lumber spondylolisthesis by using pedicle screw and interbody fusion cage

目的 观察后路椎弓根螺钉内固定联合椎间Cage植骨融合治疗腰椎滑脱症的手术疗效,并与椎间单纯颗粒植骨融合术进行对比分析.方法 2006年8月至2009年1月对46例腰椎滑脱症患者采用椎弓根钉棒系统复位内固定治疗,其中椎间Cage植骨组（A组）24例,椎间单纯自体骨粒打压植骨组（B组）22例.术前、术后随访期间拍摄X线片测量腰椎滑脱复位率、相对椎间隙高度以及腰骶角的变化,观察融合节段的融合率,并且按照日本矫形外科学会（JOA）的下腰痛评分标准进行临床疗效评价.结果 通过手术复位所有患者的腰腿疼痛症状得到缓解,且在随访18个月时显示A组滑脱复位率为94.7%、相对椎间隙高度为（74.93±7.85）%、腰骶角为36.6°±3.6°,B组分别为89.9%、（68.72±12.40）%、39.3°±5.6°,两组比较差异有统计学意义（P〈0.05）.A组植骨融合率为95.83%（23/24）,B组植骨融合率为90.91%（20/22）,两组比较差异有统计学意义（P〈0.05）.结论 采用椎弓根螺钉内固定联合椎间Cage植骨融合治疗腰椎滑脱症可有效防止腰椎滑脱复位丢失,中远期疗效明显,是治疗腰椎滑脱症较理想的方法.

Objective To observe the therapeutical effect by using pedicle screw and interbody fusion cage,and compare with posterior interbody simple autogenous bone graft. Methods From August 2006 to January 2009,46 cases of lumbar spondylolisthesis patients were treated by using pedical screw internal fixation system, including 24 cases of cage-graft （group A）, 22 cases of interbody simple autogenous bone graft （group B）, efficacy evaluation using JOA evaluation standard, and measured lumbar olisthe reset rate, relative intervertebral space height and lumbosacral angle of recovery and observed fusion rate through the preoperative and postoperative follow-up X-ray films. Results All the patients＇ waist pain symptoms relieved after operative reduction. At 18 months of follow-up , group A of lumbar olisthe reset rate was 94.7%, relative intervertebral space height was （74.93 ± 7.85）% ,lumhosacral angle was 36.6° ± 3.6° ,meanwhile group B was 89.9%, （68.72 ± 12.40）%,39.3°± 5.6°. There were significant differences between two groups （P〈0.05）. Bone graft fusion rate in group A was 95.83% （23/24）, in group B was 90.91%（20/22）, there was significant difference between two groups （P 〈 0.05）. Conclusion Pedicle screw system and interbody cage-graft in treatnent of lumber spondylolisthesis can effectively prevent the loss of reduction,mid and long-term effects are satisfactory,it is a stable and reliable method.