后路短节段钉棒系统联合环形植骨于腰椎滑脱症中的应用

Clinical application of short-segment nail-stick system combined with annular fusion in lumbar spondylolisthesis

目的探讨后路椎间融合(PLIF)联合后外侧融合(PLF)的植骨融合方法治疗腰椎滑脱症的临床效果。方法将明确诊断为腰椎滑脱症的63例患者,行后路单或双侧椎板切除、神经根管减压,清理滑脱间隙,短节段椎弓根钉棒系统复位、固定,滑脱椎体间融合器(Cage)植骨融合及后外侧植骨融合,有椎弓根峡部裂开者行峡部裂开处清理、植骨融合。分别于手术前、术后1周、术后6个月及术后12个月记录日本骨科协会(JOA)评分、腰椎前凸角、节段前凸角、椎间隙高度、滑脱率及并发症。结果63例患者均未出现严重并发症,JOA评分自术后第1周开始均有不同程度增加,随着康复时间延长,JOA评分逐渐增加,术后JOA评分改善率平均为85.00%,腰椎前凸角、节段前凸角、椎间隙高度、滑脱率较术前均有显著好转。本组患者融合率达95.24%,融合失败率为4.76%。结论 PLIF联合PLF的植骨融合方法是治疗腰椎滑脱症的理想方法之一。

Objective To investigate the clinical effect of the bone graft fusion of the posterior lumbar interbody fusion（PLIF） combined with posterolateral fusion（PLF） in treating lumbar spondylolisthesis. Methods 63 cases of lumbar spondylolisthesis were performed the posterior unilateral or bilateral vertebral plate resection, nerve root canal decompression, clearing the slippage space, reduction, fixation short-segment vertebral pedicle nail-stick system for reduction and fixation, bone graft fusion with the interverte- bral space Cage and posterior-lateral bone graft fusion, vertebral pediele isthmus cracking was performed the clearance and bone graft fusion（PLIF combined with PLF）. The JOA scores, lumbar lordosis, segment lordosis, intervertebral space height, slippage rate and complications were recorded before operation, in postoperative 1 week, 6,12 months. Results All cases had no serious complications. The JOA scores were increased to some different degrees from the beginning of postoperative 1 week,with the reha- bilitation time extension,the JOA scores were gradually increased, the improvement rate of the postoperative JOA score averaged 85.00 G. The lumbar lordosis, segment lordosis,intervertebral space height and slippage rate after operation were significantly im- proved compared with before operation,the fusion failure rate was 4.76~. Conclusion The bone graft fusion of PLIF combined with PLF is one of ideal methods to treat lumbar spondylolisthesis.