腰椎滑脱症手术治疗的临床分析

[目的]通过对82例腰椎滑脱症手术治疗病人的回顾性临床分析，探讨有关腰椎滑脱症的手术适应证、术式选择及治疗效果。[方法]依据病人情况分别采取以下4种术式：A组，后路单纯植骨融合术18例，均Ⅰ度滑脱；B组，椎弓根钉固定复位椎板间植骨融合术31例，Ⅰ度11例，Ⅱ度20例；C组，减压、椎弓根钉固定复位横突间植骨融合术19例，Ⅰ度2例，Ⅱ度13例，Ⅲ度4例，包括椎间盘突出3例，椎管狭窄3例；D组，减压、椎间融合、椎弓根钉固定复位横突间植骨融合术14例，Ⅰ度1例，Ⅱ度10例，Ⅲ度3例，包括椎管狭窄6例（Ⅰ度1例、Ⅱ度4例、Ⅲ度1例），椎间盘突出4例（Ⅱ度3例、Ⅲ度1例）。[结果]随访6个月～6a 6个月，平均3a8个月，单纯植骨融合组（A组）18例中15例融合，其融合率83％、滑脱复位率0．03％，根据下腰痛的FRS评分标准，其改善率52．69％。椎弓根钉固定复位椎板间植骨融合（B组）的31例中30例融合，其融合率96％，滑脱复位率83％，改善率56．20％。减压、椎弓根钉固定复位横突间植骨融合组（C组）融合率89％、滑脱复位率90％、改善率59．85％。减压、椎间融合、椎弓根钉固定复位横突间植骨融合组（D组）融合率100％、滑脱复位率92％、改善率61．08％。[结论]不同的手术方式针对不同的手术适应证。手术方式的不同因病人的病情不同而不同。     

过伸复位椎板扩大开窗椎体间植骨融合内固定术治疗中青年Ⅰ、Ⅱ度腰椎滑脱症

目的探讨Ⅰ度、Ⅱ度腰椎滑脱症的手术治疗经验。方法对18例中青年Ⅰ度、Ⅱ度腰椎滑脱症的患者采用过伸复位椎板扩大开窗椎体间植骨融合内固定术。结果所有患者术后均获得随访,术后随访6～12个月,平均10个月,17例症状消失,优良率94．4％,1例术后偶有下腰痛,能正常工作。结论过伸复位椎板扩大开窗椎体间植骨融合内固定术治疗腰椎滑脱症手术效果满意。     

腰椎滑脱症不同手术治疗方式的临床比较

[目的]通过对151例腰椎滑脱症手术植骨治疗病人的回顾性临床分析,探讨有关腰椎滑脱症的手术适应证、手术植骨方式选择及治疗效果。[方法]依据病人情况分别采取以下4种术式,A组:后路钉棒系统固定单纯椎板植骨融合术21例,均Ⅰ度滑脱。B组:减压、钉棒系统固定、复位、经椎管椎体间植骨融合术46例,Ⅰ度20例,Ⅱ度26例。C组:减压、钉棒系统固定、复位、经关节突椎间椎板植骨融合术29例,Ⅰ度6例,Ⅱ度16例,Ⅲ度7例;D组:减压、钉棒系统固定、复位、经关节突椎间、横突间椎板植骨融合术55例,Ⅰ度4例,Ⅱ度41例,Ⅲ度10例。[结果]随访8个月～6年,平均3年7个月,A组滑脱复位率63.22%,融合率76.12%,腰痛JOA评分改善率90.33%;B组滑脱复位率93.41%,融合率93.48%,JOA评分改善率84.61%;C组滑脱复位率90.54%,融合率94.11%,JOA评分改善率77.58%;D组滑脱复位率92.49%,融合率98.00%,JOA评分改善率79.64%。[结论]对腰椎滑脱应依据滑脱程度、临床症状、病人全身情况选择相应的手术方式。     

Buck法螺钉固定联合椎板-横突植骨术治疗腰椎椎弓峡部裂

目的 探讨Buck法螺钉固定联合椎板-横突植骨术治疗腰椎椎弓峡部裂合并轻度腰椎滑脱的手术效果。方法 应用Buck法螺钉同定联合椎板-横突植骨融合,治疗10例合并Ⅰ～Ⅱ度腰椎滑脱的腰椎椎弓峡部断裂。结果随访8个月～4年,均达骨性融合,腰痛等症状缓解。结论Buck法螺钉固定联合椎板-横突植骨融合技术治疗合并Ⅰ～Ⅱ度以内滑脱的腰椎椎弓峡部裂,手术创伤小,对腰椎生理影响小,疗效可靠。     

FJ脊柱内固定系统并椎体及横突间植骨治疗腰椎滑脱症

目的 总结采用后路椎管减压,椎体及横突间植骨和FJ脊柱内固定系统治疗腰椎滑脱症的临床疗效.方法 采用FJ系列滑脱系统对滑脱椎体进行提拉复位、固定、后路椎管减压、椎体及横突间植骨融合治疗腰椎滑脱症46例.结果 患者均获随访,时间12～36个月.28例Ⅰ度和16例Ⅱ度患者滑脱完全复位,1例Ⅱ度和1例Ⅲ度滑脱复位达90%,未见螺钉松动或断裂,无植骨块脱出,植骨均达骨性愈合.根据Amundsen评定标准:优41例,良4例,可1例.结论 应用FJ滑脱系统结合椎体及横突间植骨具有操作简便,复位效果好,植骨融合率高及固定可靠的优点,临床疗效满意.     

单椎棘横突钢丝盘绕复位固定植骨融合治疗腰椎滑脱

目的：探讨单椎棘横突钢丝盘绕复位固定植骨融合治疗腰椎滑脱的疗效。方法：对２９例Ⅰ度、Ⅱ度腰椎滑脱病人,采用单椎体棘横突钢丝盘绕提拉或升高腰桥使滑脱椎体复位,并在钢丝下行椎板、横突间及峡部裂隙内植骨固定。结果：随诊６～１８个月,拍片证实复位固定满意,植骨全部愈合,腰部功能恢复快,取得了相当满意的效果。     

强力圈、椎板下钢丝和椎弓钉联合治疗腰椎滑脱

目的 总结强力圈、椎板下钢丝和椎弓钉联合治疗腰椎滑脱的优越性。方法 应用自行设计的强力圈和滑脱复位椎弓钉加椎板下钢丝治疗腰椎滑脱３２例,滑脱程度Ⅰ度１９例,Ⅱ度９例,Ⅲ度４例;采用复位器进行复位、后路椎间和关节突及横突周围植骨。结果 术后阴访１年以上,解剖复位率９４．５％,植骨全部融合。结论 本方法的使用避免了单独使用椎弓钉复位引起的术中椎弓钉松动滑脱;减少了椎弓钉的使用数量;克服了椎弓钉进钉点受     

TENOR系统治疗腰椎滑脱的近期疗效

目的 :观察TENOR椎弓根钉系统固定及插入型融合器或横突间植骨治疗腰椎滑脱的近期疗效。方法 :从 2 0 0 0年 12月～ 2 0 0 3年 2月 ,对 3 1例腰椎滑脱患者采用腰椎管减压、插入型融合器或横突间植骨和TENOR内固定手术进行治疗。术前X线检查 :Ⅰ度滑脱 15例 ,Ⅱ度滑脱 15例 ,Ⅲ度滑脱 1例 ;L4滑脱 17例 ,L5滑脱 14例。结果 :术后平均随访 15 3个月 (12～ 2 2个月 ) ,比较手术前后临床症状和X线片滑脱复位程度 ,3 1例患者中 ,2 7例症状完全消失 ,优良率 87 1% ,解剖复位率达 93 5 %。结论 :应用TENOR内固定治疗腰椎滑脱 ,效果良好 ,复位满意。     

腰椎滑脱症外科治疗策略选择

目的探讨不同类型腰椎滑脱症及合并症的手术治疗方式、疗效及优缺点。方法2000年2月～2004年4月应用后路椎弓根螺钉复位内固定后，分别采用后外侧植骨融合术、后路椎体间植骨融合术及前路椎体问植骨融合术治疗不同类型腰椎滑脱症及合并症的患者78例，比较术后及随访时疗效、滑脱椎体复位率、椎间隙高度恢复率、植骨融合率以及复位丢失率。结果术后28例Ⅰ度滑脱及37例Ⅱ度腰椎滑脱患者获得解剖复位．9例Ⅱ度滑脱及4例Ⅲ度腰椎滑脱患者矫正至Ⅰ度滑脱。随访时总体优良率为89．72％，42例椎体间植骨患者植骨融合良好，滑脱椎体复位无丢失，椎间隙高度维持良好；36例后外侧植骨者有12例复位丢失，2例椎弓根螺钉松动，2枚椎弓根螺钉断裂：结论对小于Ⅱ度退变性腰椎滑脱合并腰椎管狭窄者宜选用后路椎弓根钉复位固定加后外侧植骨融合术；对峡部裂性腰椎滑脱合并腰椎管狭窄者宜选用后路椎弓根钉固定加椎体间植骨融合术；对Ⅱ度以上峡部裂性单纯腰椎滑脱者以及腰椎滑脱翻修者宜选用后路椎弓根钉固定加前路椎体间植骨融合术。     

退行性腰椎不稳的手术治疗

目的：探讨后路腰椎管减压、钉棒系统复位内固定、椎间融合器或横突间植骨融合治疗腰椎滑脱症的疗效.方法：对35例腰椎滑脱ugh患者进行腰椎管减压、钉棒系统复位内固定、椎间融合和横突间植骨的手术治疗.其中Ⅰ度滑脱32例,Ⅱ度滑脱3例.28例采用椎板开窗减压钉棒系统固定、横突间植骨融合术;7例采用全椎板减压钉棒系统固定、椎间融合器加植骨融合术.结果：35例中,30例术后2周内神经受压症状消失,X片显示内固定器械位置良好.5例术后出现神经症状加重：神经根刺激症状加重者4例,其中3例经治疗症状于3个月内缓解,1例症状未缓解者于术后8个月将内固定钉棒取出后症状缓解;不全瘫者1例,经二次手术探查后症状减轻.29例获得连续随访,随访时间2～3.5年,1例于术后6个月发现滑脱椎体再次轻度滑脱.1例因跌倒致椎弓根螺钉位置改变,伴有神经根刺激症状,将椎弓根螺钉取出后症状缓解,其余27例椎体滑脱完全复位,椎间融合或横突间植骨融合良好.临床疗效按照邹德威的综合评价标准评估：优20例,良7例,一般2例,优良率为93.1%.结论：后路腰椎管减压、钉棒系统复位内固定、椎间融合或横突间植骨治疗腰椎滑脱症效果满意.     

复位及短节段固定加后外侧椎间融合治疗腰椎滑脱症

目的探讨腰椎滑脱症的手术方法和疗效。方法回顾分析2002-02-2009-02收治的96例腰椎滑脱症患者,男44例,女52例,年龄36～65岁,平均50.5岁。其中,椎弓根峡部裂性滑脱43例,退变性腰椎滑脱49例,医源性滑脱4例。根据Meyerding方法确定滑脱程度:Ⅰ度滑脱71例,Ⅱ度21例,Ⅲ度4例。所有患者均采用后路减压、复位、短节段固定、经后外侧椎体间打压植骨、单枚融合器融合等方法施行手术治疗。通过JOA评分、滑脱复位率、融合率及并发症对疗效进行评估。结果随访平均为54.6个月(15-98个月),获得完整随访资料86例。术后6个月JOA评分(24.37±2.46)分,与术前(11.52±2.97)分相比,差异显著(P<0.05)。术后疗效:优30例、良48例、可8例,优良率为90.7%(78/86)。滑脱复位率达87.23%;融合率达100%;未发生固定器械断裂、融合器移位等并发症。结论后路减压、复位、短节段固定及后外侧椎间融合是治疗腰椎滑脱的良好术式。     

腰椎退行性多节段滑脱的手术治疗

目的 探讨腰椎退行性多节段滑脱的手术治疗方法.方法 2005年3月至2008年9 月,采用后路彻底减压、复位、椎弓根内螺钉固定360°融合治疗多节段腰椎滑脱患者25例.其中男性7例,女性18例;年龄38-75岁,平均56.6岁.滑脱均为退行性变化引起,类型有:前滑脱12例,后滑脱2例,混合滑脱11例.患者均行腰椎后路减压融合手术,术后随访6个月-4年,根据 Lenke 标准评价脊柱植骨融合情况,根据 Henderson 标准评价临床疗效.结果 术后25例患者均获得完全 复位.植骨融合结果:Lenke A级23例,B级2例;临床疗效Henderson评价结果:优16例,良6例,可 3例.结论 多节段腰椎退变滑脱发病机制和治疗方法与单节段腰椎滑脱不尽相同,后路彻底减压, 适度复位,后外侧植骨融合结合椎间融合能获得较好的临床效果.多节段滑脱复位时应根据滑脱的类型选择不同方法.     

腰椎滑脱发生部位性别年龄的分布特征

目的探讨腰椎滑脱好发部位、性别、年龄的分布特征。方法随机取我院（同济医院）骨科2000年1月至2006年12月期间腰椎滑脱手术病例共149例,剔除合并脊柱外伤、先天、手术后、病理性疾病等12例,对其余137例从发病部位、性别、年龄等各方面进行统计学分析。结果女性退行性腰椎滑脱总的发病数是男性的2.48倍;男女各年龄段不同部位、性别腰椎滑脱发病数呈非正态性分布;L4峡部裂性滑脱平均年龄与L5峡部裂性滑脱平均年龄之间有显著性差异;腰椎退行性滑脱发生的平均年龄为51.88岁,比峡部裂性滑脱（46.47岁）发生晚,两者有显著性差异。结论腰椎滑脱发生性别、年龄有显著性差异。女性退行性滑脱的发生率大于男性,40~60岁为腰椎滑脱的高发时段,峡部裂组发生平均年龄早于退行变组。     

Global spinal motion in subjects with lumbar spondylolysis and spondylolisthesis: does the grade or type of slip affect global spinal motion?

STUDY DESIGN: This was a prospective pilot study to investigate the global motion characteristics of the spondylolysis and spondylolisthesis populations. OBJECTIVES: The aim of this study is to determine the influence of a spondylolisthesis or a spondylolysis on global spinal motion and to establish whether this is dependent on the cause of the slip or the degree/grade of the slip. SUMMARY OF BACKGROUND DATA: The condition of spondylolisthesis has been extensively discussed in the literature with respect to its etiology and management. However, the mechanics and movement of the spine in relation to pathology and the effect of this condition on function have received scant attention. METHODS: The motion of the lumbar spine was investigated in 31 patients (19 men, 12 women, mean age 47.7 +/- 17.8 years) who were diagnosed as having either a lumbar spondylolysis or a spondylolisthesis. These patients were compared with a preexisting database of 203 normal subjects (100 men, 103 women, mean age 39.8 +/- 13.4 years). Patients were graded according to the type of spondylolisthesis or spondylolysis they had, and the extent of slip was rated using Meyerding's classification (1932) and measured directly using methods of Boxall et al (1979) and Wiltse et al (1983). RESULTS: Direct measurements of the extent of slip using Boxall et al (1979) and Wiltse et al (1983) methods were found to have no significant correlation with the resultant range of motion (ROM) or the speed of movement. This study suggests that motion parameters are influenced by the grade of slip in patients with spondylolisthesis, and the type of spondylolisthesis i.e., whether isthmic or degenerative. In the A-P flexion-extension plane, the results indicate that subjects with a defect only, i.e., a spondylolysis, and thus no slip present with a spinal hypermobility (P < 0.01). Subjects with an isthmic slip tend to be either slightly hypermobile or within the anticipated range of motion, whereas those subjects with a degenerative slip tend to be hypomobile (P < 0.05). Movements into lateral flexion were restricted in both the isthmic and degenerative spondylolisthesis patients, whereas rotation was only influenced by the level at which the defect occurred. In terms of degree of displacement, in higher grades of displacement, there was a trend towards hypermobility. CONCLUSIONS: The findings of this study suggest that the grade and type of spondylolisthesis do influence global motion parameters. This information may be useful in the clinical assessment of this patient group.     

经后路减压植骨融合RF椎弓根系统治疗腰椎滑脱症

目的探讨经后路减压植骨融合RF椎弓根系统治疗腰椎滑脱症的效果。方法2003年2月至2008年9月,36例腰椎滑脱症患者经后路采用RF椎弓根螺钉系统进行后路减压植骨融合手术治疗,其中Ⅰ度滑脱11例,Ⅱ度滑脱16例,Ⅲ度滑脱9例;退变性腰椎滑脱21例,峡部裂性腰椎滑脱15例。结果所有患者术后随访均超过12个月,平均（22．5±6．3）个月。比较手术前后临床症状及x线片。根据Asher的疗效观察项目：优22例,良10例,可3例,差1例,优良率88．9％。出现手术并发症7例,其中术中并发症3例,发生率为8．3％;术后并发症4例,发生率为11．1％。结论经后路减压植骨融合RF椎弓根螺钉系统能使腰椎滑脱得到较为确实的复位和固定,脊柱融合率高,临床效果满意。     

TLIF术式治疗双节段腰椎滑脱症的临床研究

【摘要】 目的 探讨经椎间孔椎间融合术(TLIF术)式治疗双节段腰椎滑脱症的手术疗效。方法 采用TLIF后路减压、复位、椎弓根螺钉内固定、椎间植骨融合术治疗双节段腰椎滑脱11例,按Lenke标准评价脊柱融合情况,按Henderson标准评价临床疗效。结果 所有病例均获得较大程度的复位,术后随访1~2年,根据Lenke标准评价脊柱植骨融合:A级10例,B级1例;根据Henderson标准评价临床疗效:优9例,良1例,可1例。结论〓TLIF术式治疗双节段腰椎滑脱症,其脊柱融合满意,疗效显著可靠。     

Direct repair of defect in lumbar spondylolysis and mild isthmic spondylolisthesis by bone grafting, with or without facet joint fusion

Forty-six patients with lumbar spondylolysis and mild isthmic spondylolisthesis were managed with direct repair of the defect with or without facet joint fusion in the affected segment. There were 24 males and 22 females, ranging in age from 15 to 56 years (average, 38.2 years). These patients had experienced clinical symptoms due to spondylolysis for between 4 months and 20 years (average, 5.3 years). Of 46 patients, 28 had no spondylolisthesis, 11 had Meyerding grade I vertebral slippage and 7 had grade II. Direct repair of 98 defects was performed on these patients. Twenty-six patients, in whom the disc adjacent to the defect was determined as degenerative by magnetic resonance imaging (MRI), simultaneously underwent facet joint fusion; 17 in one segment and 9 in two segments. The average period of follow-up was 50 months (24-92 months). Ninety-four defects achieved bony healing. As a result, 28 patients were graded as having an excellent outcome, 15 good, and 3 fair. Bone grafting in the defects achieves union between the loose lamina and the anterior element of lumbar vertebrae, and reconstructs the anatomic structure and physiologic functions of the lumbar vertebrae. There was no significant difference in outcome between the spondylolytic/spondylolisthetic patients with non-degenerative disc, who were treated with direct repair of defect only, and those with degenerative disc, who additionally underwent a fusion procedure (P > 0.05). The present series demonstrates a satisfactory result and a high rate of bony healing of the pars defect by this operative procedure in patients with lumbar spondylolysis and mild isthmic spondylolisthesis. Preoperative assessment of the disc degeneration with MRI is of great assistance in making the protocol choice of whether to opt for fusion.     

Anterior spondylodesis for spondylolisthesis: Isthmic and degenerative types

Summary We studied the influence of instability of the spondylolisthesic segment upon anterior interbody fusion (AIF) rates. A one-level AIF of the lumbar spine by the modified extraperitoneal Bailey-Badgley fusion construct was performed in 26 patients with chronic or recurring acute low-back pain and/or other symptoms due to grades I and II spondylolisthesis. Sixteen were degenerative type, and 10 were isthmic type. Seventeen were female and 9, male. The average age was 41.2 years. The number of cases of spondylolisthesis at the level of L4–5 and L5-S1 as 18 and 8, respectively. In the 16 cases of degenerative type, 13 were grade I slip, and 3 were grade II slip, while in the 10 cases of isthmic type, 8 were grade I slip, and 2 were grade II slip. The average postoperative follow-up was 6 years (range 2–10 years). Solid fusion was obtained in 15 (93.8%) of the cases of degenerative spondylolisthesis and in 6 of the cases of isthmic type. Thus, the overall fusion rate was 80.7% (21 cases). However, some graft crumbling and redisplacement developed in 1 of the cases of degenerative type and 6 of the cases of isthmic type. Non-union developed in 4 (57.1%) of those 7 cases of graft crumbling (3 isthmic and 1 degenerative type). Fusion took 7 months on average (range 5–9 months). It is hypothesised that the isthmic-type spondylolisthesis has more instability than the degenerative one. Therefore, AIF in the case of degenerative spondylolisthesis is a useful procedure, while in the isthmic type it is not advisable as a routine procedure.     

影响腰椎滑脱手术复位的影像学预测因素及其临床意义

目的 研究可以预测腰椎滑脱手术复位疗效的影像学因素.方法 2001年5月至2007年4月行后路椎弓根螺钉复位内固定加后外侧融合术并且有完整影像学资料的患者42例,男性11例,女性31例;年龄40～79岁,平均56.0岁.其中退变性滑脱20例,崩裂性滑脱22例.L3,4滑脱1例,L4,5滑脱26例,L5S1滑脱15例.Ⅰ度滑脱23例,Ⅱ度滑脱19例.术前及术后1周常规行腰椎正、侧位X线片检查.在术前侧位X线片上测量滑脱率、椎间隙相对高度、滑脱角、腰前凸角和骶骨倾斜角;在术后侧位片上测量术后滑脱率.对复位率与术前滑脱率、术前滑脱角、术前椎间隙相对高度、术前腰前凸角和术前骶骨倾斜角的关联性采用多元回归分析.结果 42例患者术前滑脱率(22.5±10.6)%,术前椎间隙相对高度0.23±0.10,术前滑脱角4.4°±5.4°,术前腰前凸角43°±13°,术前骶骨倾斜角34°±10°,复位率(63.2±27.9)%.复位率与术前滑脱率、术前滑脱角和术前骶骨倾斜角无明显相关性,与术前椎间隙相对高度呈正相关(P<0.05),与术前腰前凸角呈正相关(P<0.05).结论 术前椎间隙相对高度和腰前凸角可以预测腰椎滑脱手术复位疗效.     

成人腰椎滑脱症复位程度对临床疗效的影响

目的通过对Ⅱ、Ⅲ度成人腰椎滑脱症患者手术治疗的回顾性临床研究,探讨腰椎滑脱复位程度对临床疗效的影响。方法 2005年1月至2011年6月,72例成人Ⅱ、Ⅲ度腰椎滑脱症患者接受手术治疗。其中Ⅱ度滑脱52例,Ⅲ度滑脱20例;峡部裂性滑脱症24例,退行性腰椎滑脱症48例;男18例,女54例;年龄39~78岁,平均60.2岁。所有患者均行减压、椎弓根螺钉提拉复位固定、椎间或加横突间植骨融合术。以滑脱复位率作为评价腰椎滑脱复位的程度,分别是完全复位组29例,滑脱复位率100%;部分复位组38例,滑脱复位率82.5%;未复位组5例,滑脱复位率0。分别测出三组的术前滑移程度,术后滑移程度;临床疗效根据患者术前术后及末次随访时的视觉模拟疼痛评分(visual analogue scale,VAS)和日本骨科协会(Japanese orthopaedic association,JOA)功能评分进行评价,组间比较采用单因素方差分析,结果采用SPSS 19.0统计软件进行统计学相关性分析。结果 72例患者术后均获得随访,随访24~66个月,平均38个月。临床疗效评价优50例,良14例,可8例,优良率达88.89%。术后与术前VAS评分,术后及末次随访时JOA评分,术后及末次随访时的滑移程度、腰椎滑脱复位率和临床疗效满意率,未复位组与完全复位组和部分复位组两组差异有统计学意义(P0.01)。而三组间2年融合率差异无统计学意义(P0.05)。结论成人腰椎滑脱症复位程度越完全越有利于患者症状解除和明显改善,未复位组原位融合与完全复位和部分复位组临床疗效差异显著。腰椎滑移程度对远期腰椎融合率无明显影响。