椎弓根螺钉系统加cage融合器治疗腰椎滑脱症疗效分析

目的分析椎弓根螺钉系统加cage融合器治疗腰椎滑脱症的疗效。方法2003年2月～2006年3月,联合应用椎弓根螺钉系统加cage融合器治疗腰椎滑脱症患者37例。男21例,女16例;年龄39～69岁。滑脱部位：L33例,L423例,L511例。根据Meyerding滑脱程度分级标准,度滑脱12例,度滑脱20例,度滑脱5例。观察术前、术后2周及3个月随访时Taillard指数、Boxall指数、滑脱角、腰椎生理前凸角及椎间隙高度的变化情况。结果37例患者术后均获3～36个月随访。术前与术后2周Taillard指数、Boxall指数、腰椎生理前凸角、滑脱角及椎间隙高度比较,差异均有统计学意义（P〈0.05）;各指标术后3个月与术后2周比较,差异均无统计学意义（P〉0.05）。根据邹德威评分标准,优27例,良8例,可2例,优良率达94.6%。患者术后3～8个月植骨均融合,平均3.9个月。内固定材料无松动、断裂,cage融合器位置、形态正常。结论联合应用椎弓根螺钉系统和cage融合器治疗腰椎滑脱症可起到协同作用,能提供理想复位和坚强内固定,提高脊柱的融合率,是治疗腰椎滑脱症的一种较理想方法。

THERAPEUTIC EFFECT OF POSTERIOR PEDICLE SCREW SYSTEM COMBINED WITH INTERBODY FUSION CAGE ON LUMBAR SPONDYLOLISTHESIS

OBJECTIVE: To analyze the therapeutic effect of the posterior pedicle screw system combined with interbody fusion cage on lumbar spondylolisthesis. METHODS: From February 2003 to March 2006, 37 lumbar spondylolisthesis patients were treated with this operation, including 21 males and 16 females and aging 39-69 years. The affected lumbars were L3 (3 cases), L4 (23 cases), and L1 (11 cases). According to the Meyerding-evaluating system, 12 cases were classified as degree I, 20 cases as degree II, and 5 cases as degree III. Taillard index, Boxall index, slipping angle, lumbar lordosis angle and intervertebral height index were measured before operation, and 2 weeks and 3 months after operation. RESULTS: All patients were followed up 3-36 months. There were statistically significant differences in Taillard index, Boxall index, slipping angle, lumbar lordosis angle and intervertebral height index between before operation and 2 weeks after operation (P < 0.05), and no statistically significant differences between 2 weeks and 3 months after operation (P>0.05). According to Dewei Zhou's creterior for scoring, the results were excellent in 27 cases, good in 8 cases,and fair in 2 cases. The excellent and good rate was 94.6%. All of the embedded osseous were fused. The fusing time was from 3 to 8 months (mean 3.9 months). There were no breakage of screw and rod. The position and configuration of the whole cages were good. CONCLUSION: Applying the posterior pedicle screw system combined with interbody fusion cage may achieve synergism in the treatment of lumbar vertebral spondylolisthesis. Above procedure is served as solid internal fixation and offers a satisfactory reduction, and can improve the fusion rate of the spine. So it is an ideal procedure and worthily recommended method for treatment of lumbar vertebral spondylolisthesis.