椎弓根钉系统复位固定椎间融合治疗11例多节段腰椎滑脱

Pedicle screw system fixation with intervertebral fusion in treating multi-level lumbar spondylolisthesis

目的：探讨椎弓根钉系统复位固定椎间植骨融合治疗多节段腰椎滑脱的临床价值和相关问题。方法：11例多节段腰椎滑脱患者,男6例,女5例,年龄43~58岁,平均52.5岁,均为L4、5椎体滑脱,采用后路椎弓根螺钉系统复位固定,椎管减压,神经根松解,椎间植骨融合手术。术前、术后行腰腿痛视觉模拟评分（VAS）,使用Os-westry功能障碍指数（OD I）问卷调查表评价临床功能恢复情况,并通过影像学检查观察滑脱恢复情况、椎间孔高度、植骨融合情况综合评价临床疗效。结果：11例患者均获随访,随访时间1~5年,平均3年2个月,VAS评分术后（1.0±1.0）分及末次随访（1.0±0.5）分,较术前（8.0±1.5）分均有显著性差异（P〈0.005）;OD I术后（22.13±13.40）及末次随访（20.31±13.27）,较术前（64.80±15.68）均有显著差异（P〈0.005）。术后椎间隙、椎间孔高度术后较术前明显增高,无内固定松动或断钉断棒;所有病例复位满意,所有患者植骨融合良好,无假关节形成。结论：后路椎弓根钉系统复位固定,椎管减压,神经根松解,椎间植骨融合治疗多节段腰椎滑脱效果满意,该术式具有复位良好,固定牢靠,融合率高等优点。

Aim：To investigate the clinical significance and relating problems in treating multi-level lumbar spondylolisthesis with instability by transpedicular instrumentation with fusion.Methods： Eleven cases（6 males and 5 females,age range 43~58 years,mean 52.5 years） of multi-level lumbar spondylolisthesis（L4/L5 and L5/S1） with instability who underwent the transpedicular screw internal fixation with bone grafts fusion were reviewed.The clinical effect with preoperative,postoperative VAS score,ODI questionnaire and postoperative imaging about correction,foraminal height and fusion were evaluated.Results： Follow-up study for a mean period of 3.2 years（1-5years） was conducted in all the cases.VAS scores and ODI in postoperation and final follow-up was 1.0±1.0,1.0±0.5,22.13±13.40 and 20.31±13.27 respectively,there were significant difference between preoperative and postoperative（P〈0.005）.Postoperative disc height and foraminal height were significantly higher than those of preoperative disc height and foraminal height.During follow-up,there were no signs of rupture,loosing or falling in the internal fixation.No pseudarthrosis.Reduction and solid fusion of the bone graft were achieved satisfactorily in all patients.Conclusion：There are satisfactorily effects of the posterior operation with pedicle screw internal fixation,reduction,decompression in treating multi-level lumbar spondylolisthesis with instability,can achieve good reduction,reliable fixation,high fusion rate.