腰5椎体Ⅱ度以上峡部裂性滑脱的手术策略

目的探讨腰5椎体Ⅱ度以上峡部裂性滑脱的手术治疗策略。方法 2003年8月～2008年10月,应用经椎间孔腰椎间融合（transforaminal lumbar interbody fusion,TLIF）技术,以小关节突为中心椎管减压、椎间隙松解撑开复位、椎弓根钉棒系统补充复位固定、椎间隙打压植骨联合椎间融合器技术治疗腰5椎体Ⅱ度以上峡部裂性滑脱26例。结果经18～36个月（平均30个月）随访,滑脱椎体复位无丢失,椎间隙高度维持良好,下腰椎生理弧度恢复正常,椎弓根螺钉无断裂、松动,融合器无移位、沉降。25例获骨性融合。根据NaKai评分标准,优良率为84.6%。结论采用TLIF技术治疗腰5椎体Ⅱ度以上滑脱,神经根管减压是影响疗效的关键因素,滑脱椎体复位有利于神经根减压以及椎间融合率的提高,椎体间融合是维持长期疗效的基础。

Surgical strategy for high-grade isthmic spondylolisthesis of 5th lumbar vertebrae

Objective To investigate surgical strategy for high-grade isthmic spondylolisthesis（more than Ⅱ degree） of 5th lumbar vertebrae. Method From August 2003 to October 2008, 26 patients with high-grade isthmic spondylolisthesis （L5） were treated by the application of TLIF （transforaminal lumbar interbody fusion） techniques, using posterior spinal nerve canal decompression centered by lumbar zygoapophsis, intervertebral space release, distraction and reduction, supplemental reduction and fixation with pedicle screw-rod system, and intervertebral impacted bone graft combined with lumbar interbody fusion cage. Results After 18 to 36 months （average 30 months） follow-up, no loss of slipped vertebrae reduction and intervertebral height maintenance occurred, physical curvature of lumbar spine returned to normal level, and there were no patients with neither a breaking / loosening pedicle screw nor fusion cage displacement or sedimentation. Twenty-five patients achieved solid fusion. According to NaKai rating criteria, excellent rate was 84.6% . Conclusion To treat high-grade isthmic spondylolisthesis （L5）, nerve root canal decompression is the key. Slipped vertebrae reduction is conducive to nerve root decompression and intervertebral body fusion rate improvement, while this fusion is the foundation to maintain long-term efficacy.