后路椎弓根钉棒系统内固定椎间植骨术治疗腰椎滑脱伴椎管狭窄症

Posterior Pedicle Screw Internal Fixation and Interbody Fusion for the Treatment of Lumbar Spondylolisthesis with Spinal Canal Stenosis

【目的】分析经后路椎弓根钉棒系统内固定椎间植骨（PLIF）治疗腰椎滑脱症的临床疗效【方法】采用后路椎弓根钉棒系统复位内固定，椎间及横突间植骨治疗28例腰椎滑脱症患者，从滑脱复位结果，融合成功率，术前术后疼痛改善情况，腰部功能改善以及并发症等方面进行评价。【结果】28例患者平均随访13个月，滑脱完全复位25例，占89．3％，不完全复位3例，占10．7％。全部患者都获得植骨融合，融合率100％。27例术后腰腿痛即消失。1例术后疼痛改善，1个月后疼痛消失。所有患者3个月后腰部活动良好。伸0°～20°，屈0°～40°，左侧弯0°～25°，右侧弯0°～25°。本组患者无钉棒松动或断裂，无神经损伤等并发症。【结论】采用后路椎板减压椎弓根钉棒系统内固定椎间植骨融合治疗腰椎滑脱，具有复位良好，融合可靠，疗效确切的特点，且减少了腰椎术后并发征的发生率。

[Objective]To analyze the clinical efficacy of posterior pedicle screw internal fixation and interbody fusion for the treatment of lumbar spondylolisthesis. [Methods]A total of 28 patients with lumbar spondylolisthesis underwent posterior pedicle screw internal fixation, intervertebral and transverse interbody fusion. Spondylolisthesis reduction results, fusion success rate, the improvement of preoperative and postoperative pain＇ as well as lumbar function and the complications were evaluated. [Results] All 28 patients were followed up for average 13 months. Among them, 25 patients（89.3%） achieved complete reduction of spondylolisthesis, and 3 patients （10. 7%） achieved incomplete reduction of spondylolisthesis. All patients obtained bone fusion, and the fusion rate was 100%. Postoperative backieg pain of 27 patients disappeared. Postoperative pain of 1 patient relieved and then disappeared after 1 month. Lumbar activity of all patients after 3 months was good（20° extension 0°-40° flexion, lateral bending： left 25°-0°right 25°）. No pedicle screw loosening or breakage, nerve damage and other complications were found in all patients. [Conclusion] Posterior lamineetomy, pedicle screw internal fixation and interbody fusion for the treatment of lumbar spondylotisthesis has the advantages such as good reduction, reliable fusion and certain efficacy, and can reduce the incidence of postoperative symptoms in lumbar vertebrae.