退变性和峡部裂性腰椎滑脱症的治疗及比较

Comparison of clinical treatment of degenerative lumbar versus severe lumbar broken isthmus spondylolisthesis

[目的]比较采用不同植骨方式治疗腰椎滑脱症的手术疗效。[方法]2002～2010年1月,共收治腰椎滑脱症患者173例,其中退变性滑脱74例,峡部裂性滑脱99例。应用后路椎弓根钉复位内固定后,分别采用后外侧植骨融合术、后路椎体间植骨术。比较不同术式的手术时间与出血量、手术疗效及椎体滑脱复位率等。[结果]因合并糖尿病切口感染1例,经再次清创、冲洗等疗法治愈;切口脂肪液化5例,经2～3周换药后切口愈合;7例有神经根袖破裂或硬膜撕裂,术后发生脑脊液漏,观察3～7 d夹闭引流管脑脊液漏停止后拔管,经换药引流愈合;2例出现L5一侧神经根损伤。随访3～7年,平均4.2年,临床满意率退变性滑脱组86.7%,另一组为87.2%;滑脱复位率退变性滑脱组77.9%,另一组79.7%。[结论]退变性腰椎滑脱宜选用后路椎弓根钉固定加后外侧植骨融合术;峡部裂性腰椎滑脱宜选用后路椎弓根钉固定加椎体间植骨融合术,Ⅱ度以上者辅以横突间及峡部植骨。

[Objective] To investigate the surgical technique for different types of lumbar spondylolidthesis. [Methods]From 2002 to January 2010,173 cases of lumbar spondylolisthesis were treated.Of them 74 were degenerative lumbar spondylolisthesis and 99 of severe lumbar broken isthmus spondylolithesis.We used posterior pedicle screw fixation and different bone graft fusion techniques.The operative time,amount of bleeding,therapeutical effect and rate of lumbar spondylolisthesis reduction weres observed. [Results]One case had incision infetion,five had incision fat liquefaction,which was cured by dressing wound.Their were seven cases of cerebrospinal fluid leakage caused by nerve root sleeve rupture.Extubation was performed at 3～7 days and cerebrospinal fluid leakage stopped.The drainage orifice was healed by dressing change.Two cases had nerve root injuriy.Follow-up time ranged form 1 to 7 years,with an average of 4.2 years.The excellent to good outcome was 86.7% for degenerative lumbar spondylolisthesis and 87.2% for severe lumbar broken isthmus spondylolisthesis.The rates of lumbar spondylolisthesis reduction were 77.9% and 79.7%,respectively. [Conclusion]The patient with degenerative lumbar spondylolisthesis should be treated with posterior pedicle screw fixation and posterior lateral bone graft fusion.The patient with severe lumbar broken isthmus spondylolisthesis should be treated with posterior pedicle screw fixation and lumbar interbody fusion,and additional posterior circumferetial fusion for severe spondylolysis.