后路椎弓根钉固定联合椎间植骨融合治疗腰椎滑脱症

The treatment of lumbar spondylolisthesis by posterior pedicle screw fixation combined with lumbar interbody fusion

目的评价后路椎弓根钉固定联合椎间植骨融合治疗腰椎滑脱症的临床治疗效果。方法回顾性分析2006年10月至2009年10月收治的40例经后路椎弓根钉固定联合椎间植骨融合治疗腰椎滑脱症患者的临床资料。其中男22例,女18例;年龄38～75岁。滑脱部位:L4～528例,L5～S112例。根据Meyerding滑脱程度分级标准,Ⅰ度滑脱20例,Ⅱ度滑脱18例,Ⅲ度滑脱2例;峡部裂型滑脱15例,退行性滑脱25例。所有患者均采用后路减压、椎弓根螺钉系统固定联合椎间植骨融合术。结果所有患者均得到随访,随访6～18个月,平均10.7个月。患者术后4～10个月植骨均融合,平均6.5个月。无1例发生内固定器械松动、断裂。末次随访时根据日本骨科学会(JOA)评分标准:治疗后12例评分改善率为93.8%,15例为87.5%,8例为81.3%,5例为75.0%,平均改善率为86.6%,均达显效。结论后路椎弓根钉固定联合椎间植骨融合是治疗腰椎滑脱症的理想、有效的方法。

Objective To investigate the curative effect for lumbar spondylolisthesis by posterior pedicle screw fixation combined with lumbar interbody fusion. Methods Clinical data of 40 patients （male 22 cases,female 18 cases, aged 38 - 75 years） of lumbar spondylolisthesis treated by posterior pedicle screw fixation combined with lumbar interbody fusion from October 2006 to October 2009 were retrospectively analyzed. The levels of spondylolisthesis were L4_5 in 28 cases, L5 - S1 in 12 cases, respectively. According to Meyerding＇s classification,20 cases were degree Ⅰ , 18 cases were degree Ⅱ, and 2 cases were degree Ⅲ. Lumbar isthmic spondylolisthesis was 15 cases, and degenerative spondylolisthesis was 25 cases. All of the patients were treated by posterior decompression plus pedicle screw fixation combined with lumbar interbody fusion. Results All cases were followed up for 6 - 18 months（ average 10.7 months）. The mean time of bony fusion was 6.5 months with a range of 4 - 10 months. All of the internal fixation didn＇t loose and break. At the final follow-up, according to Japanese Orthopedic Association （JOA） score classification, the recovery rate was 93.8% in 12 cases, 87.5% in 15 cases, 81.3% in 8 cases, 75. 0% in 5 cases respectively, and the average recovery rate was 86.6%. Conclusions Posterior pedicle screw fixation combined with lumbar interbody fusion is an ideal and effective treatment method for lumbar spondylolisthesis.