Steffee手术治疗崩裂性腰椎滑脱症的远期疗效

Long term follow- up study of lumbar spondylolytic spondylolisthesis treated with Steffee system

目的研究 Steffee手术治疗崩裂性腰椎滑脱症的远期疗效并分析术前、术后影像学特征。方法 34例崩裂性腰椎滑脱症患者全部实施 Steffee手术及后外侧融合术 (posterolateral fusion, PLF)，并进行影像学观测，其指标包括滑脱率、滑脱角、椎间隙高度、椎间孔高度、融合率、断钉率和主、客观疗效评价。结果 Steffee手术加 PLF，术后 45.1％滑脱复位，椎间隙、椎间孔高度增加，滑脱角改善；随访 3年～ 8年 8个月，平均 6年 5个月，矫正度有一定程度的丢失，融合率为 88.2％，断钉率为 2.9％；临床疗效主观评估优良率高于客观评估。结论崩裂性腰椎滑脱伴神经根症状建议充分减压，最大限度复位，滑脱角大者应行椎体间支撑植骨融合。疗效评估以客观计分方式为佳。

Objective To evaluate the long term outcome of spondylolytic spondylolisthesis treated with Steffee system and posterolateral fusion. Methods Thirty- four patients were followed up for an average of 77.2 months. The follow- up study include slipping percentage, slipping angle, heights of intervertebral space and foramen, fusion rate, screw broken rate and clinical outcomes. Results 1) Solid fusion was obtained in 88.2％ of patients. screw broken rate was 2.9％ . 2) Comparison of pre- and post- operative slip showed correction rate of 45.1％ . The heights of intervertebral space and foramen increased, slipping angle decreased. 3) During the period of follow- up, recurrence of deformity was found. 4) The subjective outcome was better than the objective outcome. Conclusion 1) Lumbar spondylolytic spondylolisthesis with radicular symptom need complete decompression and reduction as much as possible. 2) A positive slipping angle indicates significant shearing force and the need of an interbody fusion to restore the weight- bearing capacity. 3) Objective criteria is more suitable to evaluate surgical outcome.