腰椎崩裂性滑脱椎弓钉复位固定椎体间植骨融合术

Treatment of Lumbar Spondylolisthesis by Transpedicular Fixation and Intervertebral Body Fusion

目的 比较腰椎崩裂性滑脱椎弓钉复位固定椎体间植骨融合术与椎体后外侧植骨融合术两种方法的优劣。方法 统计1 1 7例腰椎崩裂性滑脱病人行椎弓钉复位固定 +植骨融合术后疗效 ,其中滑脱椎体复位固定 +椎体后外侧植骨融合术 90例 ,滑脱椎体复位固定 +椎体间植骨融合术 2 7例 ,内固定于术后一年取出。结果 术后 2年脊柱滑脱程度 ,后外侧组为 1 5 9% ,椎体间组 3 9% ,后外侧组植骨融合率为 92 2 % ,椎体间组为 1 0 0 % ,腰腿痛症状改善的评价采用JOA标准 (满分为 2 9分 ) ,后外侧组术后平均为 2 2 3分 ,椎体间组为 2 6 3分 ,后外侧组术后 73 3%的人能参加一般的体力劳动和家务活 ,椎体间组为88 9% ,后外侧组术中平均输血 1 0 0 0ml,椎体间组术中平均输血 1 0 0ml,并发症发生率两个组无明显差异 ,绝大多数并发症临床上无重要意义。结论 椎弓钉腰椎复位固定 +椎体间植骨融合术更符合生物力学原理 ,能更有效矫正腰椎滑脱 ,增加植骨融合率 ,防止术后再滑脱 ,改善患者症状更明显 ,而且手术相对简单 。

Objective To present the effect on lumbar spondylodesis of patients with lumbar or lumbosacral posterolateral body fusion or intervertebral fusion with pedicle screw internal fixation.Methods Ninty patients were given lumbar or lumbosacral posterolateral fusion.Twenty-seven patients were performed intervertebral fusion.The internal device was removed one year after the fusion.Results The formers fusion rate was 92 2%,the latters was 100%.The disability was assessed using the JOA score.The formers mean score was 22 3 two years after the fusion,the latters was 26 3.Two years postoperatively,73 3% patients held jobs in the former group,and 88 9% patients in the latter group.Two years postoperatively,there was a mean vertebral slip of 15 9% in the former group ,and 3 9% in the latter group.Conclusion The intervertebral fusion is more effective than the lumbar or lumbosacral posterolateral fusion.Complications due to the intervertebral fusion are of no clinical importance.