单枚斜向Cage、脊柱滑脱复位内固定系统加后路减压术治疗腰椎滑脱症

目的探讨后路腰椎管减压、脊柱滑脱复位内固定系统(spondylolisthesis reduction system,SRS)复位内固定、单枚斜向Cage和小关节突间植骨治疗腰椎滑脱并腰椎管狭窄的临床疗效。方法2002年6月-2006年6月,对58例腰椎滑脱患者行后路腰椎管减压、SRS复位内固定、单枚斜向Vigor Spacer Cage椎间融合和小关节突间植骨的手术治疗。男47例,女11例;年龄32～66岁,平均45.8岁。病程3个月～7年,中位病程25个月。根据Meyerding分类法,Ⅰ度滑脱38例,Ⅱ度滑脱20例。L4、5滑脱21例,L5、S1滑脱37例。44例为峡部裂性,14例为退行性。椎间高度1.5～10.5mm,平均5.1mm。结果患者手术时间50～90min,平均65min;术中出血量200～500mL,平均250mL。术后切口均Ⅰ期愈合,无术后并发症发生。58例均获随访,随访时间10～38个月,平均23.6个月。根据Macrab评定标准,优54例,良3例,可1例,优良率98.3%。Ⅰ度滑脱者完全复位;Ⅱ度滑脱19例完全复位,1例复位1/2;完全复位率98.3%。术后3～6个月57例椎间融合,融合率98.3%。患者椎间高度恢复至9.6～12.5mm,平均11.6mm,且随访期内无高度丢失。结论后路腰椎管减压、SRS复位内固定、单枚斜向Vigor Spacer Cage椎间融合和小关节突间植骨治疗腰椎滑脱,效果良好,复位稳定满意。

TREATMENT OF LUMBAR SPONDYLOLISTHESIS WITH SPONDYLOLISTHESIS REDUCTION SYSTEM INTERNAL FIXATION AND DECOMPRESSION,POSTERIOR ALONE INTERBODY CAGE FUSION AND BONE GRAFTING

Objective To investigate the clinical outcomes of lumbar spondylolisthesis associated with lumbar spinal stenosis through decompressive laminectomy,spondylolithesis reduction system(SRS)internal fixation,single posteriolateral Vigor Spacer threaded fusion cages and intertransverse process arthrodesis bone grafting.Methods From June 2002 to June 2006,58 cases of lumbar spondylolisthesis were treated with decompressive laminectomy,fixed by SRS instrumentation,posterior installed with interbody Vigor Spacer Cage and bone grafted between intertransverse process arthrodesis.There were 47 males and 11 females,aged 32-66 years old(45.8 on average).The course of disease was 3 months to 7 years,with an medium course of 25 months.Accoding to the Meyerding standard,38 cases were classified as degree I and 20 as degree II.Spondylolisthesis between L4 and L5 covered 21 cases and between L5 and S1 covered 37 cases.There were 44 cases of lumbar spondylolisthesis and 14 of degenerative lumbar spondylolisthesis.The intervertebral height was 1.5-10.5 mm with the average of 5.1 mm.Results All patients'incisions obtained healing by first intension after operation.The operation time was 50-90 minutes with an average of 65 minutes.The blood loss was 200-500 mL with an average of 250 mL.The patients were followed up for 10-38 months with an average of 23.6 months.According to the Macrab criteria,54 cases were excellent,3 good,1 fair and the choiceness rate was 98.3%.According to the Meyerding classification,38 cases of degree I and 19 out of 20 cases of degree II obtained complete reduction,and the rate of complete reduction was 98.3%.There were 57(98.3%)cases which fused well 3-6 months after operation.The intervertebral height resumed to 9.6-12.5 mm with an average of 11.6 mm,and no intervertebral height loss was found.Conclusion The treatment of lumbar spondylolisthesis with decompressive laminectomy,SRS internal fixation,single posteriorolateral Vigor Spacer threaded fusion cage and bone grafting has excellent clinical results and stable reduction.