环360°减压融合椎板原位回植椎管重建术治疗峡部裂性腰椎滑脱症

In situ reimplantation of lamina to restore spinal canal with 360°decompression and fusion for lumbar isthmic spondylolisthesis

背景：对于峡部裂性腰椎滑脱，将椎板作为植骨材料用于植骨融合的研究报道甚少，本回顾性研究将报道原位椎板回植技术及其临床结果。 目的：探讨后路环360°减压、椎板原位回植、椎管重建、短节段钉棒复位内固定植骨融合治疗峡部裂性腰椎滑脱的疗效。 方法：选取2007年6月至2011年6月间在我院行后路环360°减压植骨融合、椎板原位回植、椎管重建、短节段钉棒复位内固定的峡部裂性腰椎滑脱症患者36例。男13例，女23例；年龄32~58岁，平均（40.2±9.8）岁。术后定期随访，观察融合情况、椎管成形情况及有无内固定并发症发生，通过对术后疗效评分，比较术前与术后ODI、VAS评分差异观察临床疗效。 结果：本组手术时间90~190 min，平均135 min；术中出血量200~900 ml，平均500 ml。术后随访6~36个月，平均26个月。所有患者下肢根性症状均消失，23例患者腰部持续疼痛消失，11例腰部劳累及长距离行走后疼痛患者均恢复正常工作。无神经损伤，无感染、椎间融合失败及断钉断棒、螺钉松动现象发生。原位回植椎板无吸收，椎体后方及椎体间均成骨性融合。临床疗效评定分级，优32例，良2例，可2例，差0例，优良率为94.4%。ODI评分及VAS评分术后均较术前显著改善（〈0.05）。 结论：后路环360°减压、椎板原位回植、椎管重建、短节段钉棒复位内固定植骨融合术治疗峡部裂性腰椎滑脱效果满意，既可充分显露行神经根管减压，又可重建恢复椎管的完整性，预防术后瘢痕增生黏连对椎管内脊髓及神经根的压迫。

Background：There are few literatures on the use of lamina as a graft for fusion in lumbar isthmic spondylolisthesis （LIS）. In the present retrospective clinical study, we used the laminoplasty technique and reported its outcomes. 〈br〉 Objective：To evaluate the clinical efficacy of in situ reimplantation of lamina to instore spinal canal with 360＆#176; decompres-sion and fusion for LIS. 〈br〉 Methods：Form June 2007 to June 2011, 36 LIS patients treated with in situ reimplantation of lamina to restore spinal canal with 360＆#176; decompression and fusion in our hospital were recruited in this study. There were 13 males and 23 females with an average age of （40.2＆#177;9.8） years （range, 32-58 years）. All patients were followed up regularly to evaluate the fusion and compli-cations of implants. The pre-operative and post-operative ODI and VAS scores were compared to identify the clinical efficacy. 〈br〉 Results：The mean operation time was 135 min （90-190 min）, mean blood loss was 500 ml （200-900 ml）, and the duration of follow-up was 26 months （6-36 months）. At the last follow-up, the radiating leg pain of all patients and persistent low back pain of 23 patients disappeared, 11 patients with low back pain after overwork or walk recovered to work. No nerve in-jury, infection or complications of implants occurred. Excellent clinical outcomes were achieved in 32 patients, good in 2, and fair in 2 with the excellent-good rate being 94.4%. The post-operative ODI and VAS scores were significantly higher than pre-operative ones （P＆lt;0.05）. 〈br〉 Conclusions：The in situ reimplantation of lamina to restore spinal canal with 360＆#176; decompression and fusion for LIS was satisfactory. It can not only facilitate the decompression of nerve root and the restoration of the integrity of spinal canal, but＆amp;nbsp;also prevent the formation of scar which may cause the compression of the spinal cord.