360°植骨融合术治疗腰椎滑脱症的近期疗效观察

Short-term Curative Efficacy of 360-degree Interbody Fusion for Lumbar Spondylolisthesis

目的探讨后路手术中360°植骨融合术治疗腰椎滑脱症的近期疗效。方法 2008年1月-2011年2月收治39例腰椎滑脱症患者,男21例,女18例;年龄35～75岁,平均51岁。病程12～50个月,平均31个月。滑脱部位:腰3 1例,腰4 11例,腰5 24例,腰4、5 3例。腰椎退变性滑脱27例,峡部裂性滑脱12例。按Meyerding分度:Ⅰ度21例,Ⅱ度13例,Ⅲ度5例。患者均有腰腿痛症状,保守治疗无效后行后路减压、复位及椎弓根钉棒系统内固定,术中以360°行椎间及后外侧三维立体植骨融合,在椎体前中柱采用植骨加椎间融合器的融合方式。术后定期随访,摄X线片检测融合情况,使用视觉模拟疼痛(VAS)评分评估症状缓解情况,Greenough-Fraser综合评分评价腰腿痛治疗结果。结果有36例患者获随访,随访时间12～36个月,平均24个月。植骨愈合率100%,愈合时间10～18个月,平均14个月。无内固定松动、断裂、外露及脱落等并发症发生。术前下肢神经根痛VAS评分为(7.52±1.23)分,末次随访时为(1.67±1.18)分;下腰痛术前(6.83±1.51)分,末次随访时为(1.11±0.76)分;手术前后比较差异均有统计学意义(P<0.05)。Greenough-Fraser综合评分术前为(24±7)分,末次随访时为(55±4)分,差异有统计学意义(P<0.05)。结论 360°植骨融合术治疗腰椎滑脱症是一种确实有效的融合方法,利于提高相应区域的植骨融合率及恢复椎间隙高度,使融合更稳定。

Objective To study the short-term efficacy of bone grafting circumferential fusion in treating lumbar spondylolisthesis.Methods From January 2008 to February 2011,39 lumbar spondylolisthesis patients including 21 males and 18 females were treated in our department.The age of the patients ranged from 35 to 75 years old with an average of 51.The disease course ranged from 12 to 50 months,averaging 31 months.The lesion location was as follows： one case was at L3,11 at L4,24 at L5,and 3 at L4 and L5.There were 27 cases of regressive lumbar spondylolisthesis and 12 cases of split lumbar spondylolisthesis.According to Meyerding categorizing,there were 21 cases of degree-1 spondylolisthesis,12 degree-2,and 5 degree-3.All the patients were with lumbocrural pain.After the failure of traditional treatment,they were treated with posterior decompression,reposition and pedicle screw system fixation.In the operation, three dimensional bone grafting from front,middle,and back circumferentially was performed.The fusion of grafting bones with cage together in the middle and back vertebrae was carried out.We followed up the patients regularly after surgery. X-ray pictures were taken to detect fusion conditions.VAS pain scores were used to estimate remission situation,and Greenough-Fraser Grade was adopted to assess the therapeutic outcome for lumbocrural pain.Results Thirty-six patients were followed up with a period of 12 to 36 months averaging at 24 months.One hundred percent of healing rate was achieved in bone grafting with the healing time of 10 to 18 months averaging 14 months.No internal fixation loosening,breaking, exposing or falling off occurred.Lower limb nerve root pain VAS score was 7.52 ± 1.23 points before surgery,and 1.67 ± 1.18 points during the final follow-up;those two numbers for low back pain were respectively 6.83 ± 1.51 and 1.11 ± 0.76. The differences before and after surgery were statistically significant（P 0.05）.Greenough-Fraser overall rating score was 24 ± 7 points before surgery,and 55 ± 4 points during the final follow-up,between which there was a significant difference（P 0.05）.Conclusions Circumferential fusion is an effective way of bone grafting in the clinical treatment of lumbar spondylolisthesis.It helps to raise the fusion rate of bone grafting within relative areas and procure high recovery of relevant intervertebral space,which can make the fusions more stable.