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.     

Surgical treatment of symptomatic degenerative lumbar spondylolisthesis by decompression and instrumented fusion

Degenerative spondylolisthesis is characterized by the slippage of one vertebral body over the one below, with association of intervertebral disc degeneration and degenerative arthritis of the facet joints, which cause spinal stenosis. The aim of this study was to evaluate the clinical and radiographic results of 22 patients with symptomatic degenerative spondylolisthesis, operated on by decompressive laminectomy and instrumented posterolateral fusion associated with interbody fusion (PLIF). Mean age at surgery was 64 years (range, 57–72). Clinical results were evaluated on a questionnaire at the last follow-up visit concerning postoperative low back and leg pain, restriction of daily life activities, and resumption of sports activity. Lumbar spine radiographs were used to evaluate the status of fixation devices, the reduction of the spondylolisthesis, the lumbar sagittal balance and the presence of spinal fusion. No intraoperative or postoperative complications were encountered. There were no superficial or deep infections, fixation device loosening, or hardware removal. Mean follow-up time was 4 years (range, 3–6 years). Clinical outcome was excellent or good in 19 patients and fair in 3 patients. Preoperatively, mean forward vertebral slipping on neutral lateral radiographs was 5 mm, while postoperatively it decreased to 3 mm. Preoperatively, mean sagittal motion was 3 mm and angular motion was 8°, while postoperatively these values decreased to 1 mm and 1°, respectively. This study demonstrated that spinal decompression followed by transpedicular instrumentation associated with PLIF technique is a valid surgical option for the treatment of degenerative spondylolisthesis with symptomatic spinal stenosis. Clinical outcome, intended as relief of pain and resumption of activity, was improved significantly and fusion rate was high.     

Clinical and radiographic outcomes of bilateral decompression via a unilateral approach with transforaminal lumbar interbody fusion for degenerative lumbar spondylolisthesis with stenosis

Background Context

Laminectomy with posterior lumbar interbody fusion (PLIF) has been shown to achieve satisfactory clinical outcomes, but it leads to potential adverse consequences associated with extensive disruption of posterior bony and soft tissue structures.

Union versus nonunion after posterolateral lumbar fusion: a comparison of long-term surgical outcomes in patients with degenerative lumbar spondylolisthesis

It has been reported that in patients undergoing posterolateral lumbar fusion (PLF), the fusion status is not related to the short-term operative results. To determine whether the fusion status influences the long-term operative results of PLF, we retrospectively examined the surgical outcomes of uninstrumented PLF for a minimum of 8 years (average, 9.5 years), by comparing cases exhibiting union with those exhibiting nonunion. Uninstrumented PLF was performed for the treatment of lumbar canal stenosis (LCS) with degenerative spondylolisthesis. Since nine patients were lost to final follow-up, the study included 42 patients, and the follow-up rate was 82.4%. The mean age of the patients was 64.1 years (range 46–77 years). Eight patients exhibited fusion at the L3–4 level and 34 patients, at the L4–5 level. The fusion status was assessed using plain radiographs. The clinical outcomes were evaluated using the Japanese Orthopaedic Association (JOA) scores. Nonunion was noted in 26% (11/42) of the patients. There were no statistically significant differences between the groups exhibiting union and nonunion with respect to age, sex, preoperative JOA score, or preoperative lumbar instability. The union group achieved better operative results than the nonunion group at the 5-year and final follow-up (P = 0.006 and 0.008, respectively) although there was no significant difference in the percent recovery at 1 and 3-year follow-up (P = 0.515 and 0.506, respectively). A stepwise regression analysis revealed that the best combination of predictors for percent recovery at the time of final follow-up included the fusion status and the presence of comorbid disease. The results indicate that the fusion status following PLF is a critical factor influencing the long-term but not short-term operative results in the treatment of LCS with degenerative spondylolisthesis.     

腰椎管狭窄症伴不稳定性腰椎退变性滑脱的手术治疗

目的　探讨腰椎管狭窄伴不稳定性腰椎退变性滑脱的手术治疗疗效。　方法　回顾性分析 86例腰椎管狭窄伴不稳定性腰椎退变滑脱的手术治疗结果 ,其中男 30例 ,女 5 6例 ,年龄 30～ 77岁 ,平均 5 5 8岁 ,腰痛合并双侧下肢痛 6 3例 ,单侧下肢痛 10例 ;单纯腰痛 13例 ,其中 72例主诉间歇性跛行 ,出现跛行的行走距离 10～ 10 0 0m ,32例合并有足部感觉、运动及反射的改变。本组病例均并存病变节段的腰椎动力性腰椎不稳 ,滑脱Ⅰ° 79例 ,Ⅱ° 7例。术前CT检查 5 6例 ,MRI检查 2 4例 ,MRM检查 6例 ,术前同时行脊髓造影 6 1例 ,CTM检查 12例。狭窄并滑脱的节段 :L4 549例 ,L3 46例 ,L5 S12 5例 ,L3 4、L4 52例 ,L3 S14例。单纯侧隐窝狭窄 10例 ,双侧侧隐窝狭窄 2 2例 ,中央椎管狭窄 5 4例 ;合并椎间盘突出 12例。所有的患者均经手术减压、植骨融合及不同的内固定治疗。　结果　患者均经 8个月～ 13年的随访 ,其中随访 1年以上者 81例 (平均 5 6年 )。本组优 78例 ,良 5例 ,可 3例。滑脱完全复位Ⅰ° 70例 (89 9% ) ,Ⅱ° 6例 (85 7% )。随访过程中无滑脱加重患者 ,3个月内植骨融合者 74例 ,6个月内植骨融合 10例 ,出现假关节 2例。术后发生内固定断裂 1例 ,晚发感染 1例。结论　减压和脊柱固定可改善腰椎管     

后路椎弓根钉棒复位椎间融合器固定术治疗腰椎退行性滑脱

目的:探讨应用后路椎弓根钉棒复位椎间融合器固定术(简称为后路斜方向腰椎椎间关节固定术,POLAr)治疗退行性腰椎滑脱的临床效果。方法:应用POLAr治疗46例腰背痛及下肢根性疼痛的腰椎退行性滑脱患者,术前和术后对患者进行视觉疼痛评分(visualanaloguepainscore,VAS)、腰功能评分(lowbackoutcomescore,LBOS)和手术满意度问卷调查,评价治疗效果。结果:随访12～60个月,平均28.5个月。术前VAS和LBOS评分分别是6.2±2.5分和23.6±16.5分,随访时为2.3±1.8分(P<0.01)和48.4±20.2分(P<0.01)。46例患者中43例(93%)认为手术效果优良。滑脱由术前28.6%减少到术后的3.7%(P<0.01)。腰椎前凸由术前平均12.1°改善到术后的18.2°(P<0.01),没有与器械相关的并发症发生。结论:后路斜方向腰椎椎间关节固定术是一种安全有效的治疗退行性腰椎滑脱的手术方法。     

Posterior decompression and in situ fusion for the treatment of degenerative scoliosis

Surgical Principles Asymmetric disc degeneration in the lumbar spine often creates a segmental instability that will result in progressive arthrosis of the facet joints and development of a lumbar scoliosis. Although the progression of the curve is slow, it may cause in the adult and elderly significant back pain and radicular pain [2, 3]. If conservative management fails, then surgical treatment should consist of a thorough decompression of the involved nerve roots and fusion of the involved vertebral segments. The technique described advocates an in situ fusion with no attempt at correction of the deformity and no use of instrumentation. This procedure is often required in elderly, osteopenic patients with systemic illnesses and therefore is designed to minimize intra- and postoperative morbidity.     

Clinical outcomes of microscopic decompression for degenerative lumbar foraminal stenosis: a comparison between patients with and without degenerative lumbar scoliosis

We performed microscopic lumbar foraminotomy in all the patients diagnosed with degenerative lumbar foraminal stenosis (DLFS) and retrospectively reviewed the clinical outcomes and the factors influencing them. The preoperative Japanese Orthopaedic Association (JOA) score of 13.8 significantly improved to 21.9 postoperatively. Although leg pain reduced in 44 patients (95.7%) immediately after surgery, it recurred in 9 patients (19.6%). The recurrence frequency was significantly higher and the JOA score improvement ratios significantly lower in patients with degenerative lumbar scoliosis (DLS) than in those without DLS. Even among patients with DLS, those with <3° Cobb angle difference between the supine and standing positions showed satisfactory results, with no recurrence. In conclusion, microscopic lumbar foraminotomy for DLFS produced satisfactory clinical outcomes even in patients with DLS. However, the outcomes were poor in patients with unstable DLS.     

改良TLIF联合术中撑开复位治疗退变性腰椎滑脱症

目的探讨改良经腰椎椎间孔椎体间融合术（TLIF）联合术中撑开复位技术治疗退变性腰椎滑脱症的可行性及其临床疗效。方法回顾性分析2007年3月至2011年10月复旦大学附属华山医院采用改良TLIF联合术中撑开复位技术治疗的84例单节段退变性腰椎滑脱症患者的临床资料,评估手术前后视觉模拟量表（VAS）疼痛评分、日本骨科学会（JOA）评分、融合节段椎间隙高度、腰椎前凸度（Cobb角）和椎体滑脱程度,X线片或CT扫描观察患者术后3个月、1年的影像学融合情况。结果平均手术时间（170±38）min、术中平均失血量（274±82）mL。截至术后3个月,全部患者获得有效随访;截至1年,84例患者中获随访79~EJ（94％）。术后3个月及1年,融合节段椎间隙高度较术前有明显提高（JP〈0．05）,但手术前后Cobb角无明显差异（P〉0．05）;术后3个月,腰椎滑脱完全复位34例（40％）,余50例患者术后腰椎滑脱得到不同程度复位;术后1年,椎体滑脱程度改善率为84％。术后3个月及1年,患者VAS评分、JOA评分均较术前明显好转（P〈0．05）;根据JOA评估标准,优59例、良20例、可5例,平均改善率为87％。57例（68％）患者术后3个月达到影像学融合标准,79例（100％）患者术后1年达到影像学融合标准。患者均未出现神经根损伤、硬膜囊撕裂、椎弓根螺钉松动断裂、椎间融合器移位下沉等。结论改良TILF联合术中撑开复位治疗单节段退变性腰椎滑脱症安全有效。     

解剖学因素在退变性腰椎滑脱发生中的意义

目的:探讨退变性腰椎滑脱(degenerative lumbar spondylolisthesis,DLS)的解剖学危险因素。方法:以2009年7月~2010年9月在我院确诊的60例DLS患者为观察对象(滑脱组),男20例,女40例,年龄51~75岁,平均65.3±7.8岁,L4滑脱42例,L5滑脱18例。以性别和年龄匹配无DLS的60例健康志愿者为对照(对照组)。在腰椎侧位X线片上测量腰椎前凸角(lumbar lordosis angle,LLA)、骶骨水平角(sacral horizontalangle,SHA)及滑脱节段(对照组取相应节段)的椎体指数(lumbar index,LI)、椎间盘角度(disc angle,DA)、椎间盘高度(disc height,DH),在腰椎正位X线片上测量L5横突的长度(the length of transverse process of L5,TPL)和宽度(the width of transverse process of L5,TPW)。采用t检验比较两组间各指标的差异,应用Logistic逐步回归分析影响退变性腰椎滑脱的解剖学危险因素。结果:滑脱组患者LLA、SHA、LI、DA、DH分别45.83°±10.42°、28.35°±11.16°、0.85±0.13、7.24°±3.83°、9.12±2.73mm;对照组分别为47.48°±10.75°、23.16°±10.68°、0.96±0.10、9.68°±5.54°、10.54±2.48mm,两组间SHA、LI、DA、DH有显著性差异(P<0.05),LLA无显著性差异(P>0.05)。滑脱组TPL、TPW分别为2.15±0.43cm、1.64±0.41cm,对照组为2.06±0.39cm、1.57±0.32cm,两组间比较无显著性差异(P>0.05)。Logistic回归分析结果显示DLS与LI、DA有显著性相关关系,回归系数分别为-1.693、-1.406。结论:DLS患者的LI下降,DA减小,其可能是DLS的危险因素。     

退行性腰椎滑脱术后脑脊液漏的发生率及原因分析

目的:探讨退行性腰椎滑脱术后脑脊液漏的发生率及危险因素,为临床预防脑脊液漏的发生提供依据。方法:收集我院2008年1月~2014年12月收治的201例单节段退行性腰椎滑脱初次手术患者的病史资料,根据是否并发脑脊液漏分为观察组和对照组,分析患者的性别、年龄、吸烟史、饮酒史、是否合并糖尿病、体重指数(body mass index,BMI)、手术方式[腰椎后路椎间融合(PLIF)或经椎间孔椎间融合(TLIF)]、滑脱部位、滑脱程度(Meyerding分度)、手术时间及术者年资与术后脑脊液漏发生率的关系。结果:201例患者中共有20例并发脑脊液漏,发生率为9.95%(20/201)。单因素分析结果显示两组病例在手术方式、滑脱程度、手术时间、术者年资方面差异有统计学意义(P0.05);多因素Logistic回归分析显示,手术方式(PLIF与TLIF相比:OR=4.572,95%CI=1.192~17.534)、滑脱程度(Ⅰ度滑脱与Ⅱ度及Ⅱ度以上滑脱相比:OR=0.172,95%CI=0.059~0.500)是退行性腰椎滑脱术后并发脑脊液漏的危险因素(P0.05)。结论:手术方式和滑脱程度影响退行性腰椎滑脱术后脑脊液漏的发生率。     

Motion characteristics of the lumbar spinous processes with degenerative disc disease and degenerative spondylolisthesis

Objective

Recently, interspinous process devices have attracted much attention since they can be implanted between the lumbar spinous processes (LSP) of patients with degenerative disc disease (DDD) and degenerative spondylolisthesis (DLS) using a minimally invasive manner. However, the motion characters of the LSP in the DLS and DDD patients have not been reported. This study is aimed at investigating the kinematics of the lumbar spinous processes in patients with DLS and DDD.

Methods

Ten patients with DDD at L4–S1 and ten patients with DLS at L4–L5 were studied. The positions of the vertebrae (L2–L5) at supine, standing, 45° trunk flexion, and maximal extension positions were determined using MRI-based models and dual fluoroscopic images. The shortest ISP distances were measured and compared with those of healthy subjects that have been previously reported.

Results

The shortest distance of the interspinous processes (ISP) gradually decreased from healthy subjects to DDD and to DLS patients when measured in the supine, standing, and extension positions. During supine-standing and flexion–extension activities, the changes in the shortest ISP distances in DDD patients were 2 ± 1.2 and 4.8 ± 2.1 mm at L4–L5; in DLS patients they were 0.5 ± 0.4 and 2.8 ± 1.7 mm at L4–L5, respectively. The range of motion is increased in DDD patients but decreased in DLS patients when compared with those of the healthy subjects. No significantly different changes were detected at L2–L3 and L3–L4 levels.

Conclusion

At the involved level, the hypermobility of the LSP was seen in DDD and hypomobility of the LSP in DLS patients. The data may be instrumental for improving ISP surgeries that are aimed at reducing post-operative complications such as bony fracture and device dislocations.     

退变性腰椎滑脱中腰椎-骨盆结构参数的特点分析

目的:分析退变性腰椎滑脱(degenerative lumbar spondylolisthesis,DLS)中腰椎-骨盆结构特点及其在退变性腰椎滑脱症中的意义。方法:对2015年4月至2017年1月收治的45例单纯退行性L_4,5节段腰椎滑脱患者(滑脱组)的临床资料进行回顾性分析,并与同期50例(对照组)体检资料齐全的健康者进行比较。通过影像学资料对受试者的腰椎-骨盆结构参数进行统计分析,分析DLS患者的脊柱-骨盆特点。观察退变性腰椎滑脱患者椎间盘及关节突关节退变特点。利用Spearson分析各观察项目之间的相关性。结果:滑脱组L_4,5关节突关节角、腰椎前凸角、骨盆入射角、骨盆倾斜角、骶骨倾斜角为(36.5±11.2)°、(44.2±7.3)°、(66.5±11.6)°、(22.2±10.0)°、(33.4±11.3)°。对照组L_4,5关节突关节角、腰椎前凸角、骨盆入射角、骨盆倾斜角、骶骨倾斜角为(44.4±8.2)°、(36.7±8.5)°、(55.4±13.2)°、(14.4±7.0)°、(42.3±13.1)°,滑...     

高龄腰椎管狭窄症患者的手术方式选择及疗效

目的 :探讨高龄腰椎管狭窄症患者的手术方式选择及其疗效。方法 :回顾分析2012年3月~2015年3月在我院行手术治疗并获得至少1年随访的39例80岁以上腰椎管狭窄症患者的临床资料,男21例,女18例;年龄80~90岁(82.4±3.1岁)。术前13例伴有一种合并症,12例伴有两种或两种以上合并症。按相关科室会诊意见处理合并疾病,应用美国麻醉医师协会(ASA)体格状态分级评估患者可耐受全麻下手术。12例根性疼痛和间歇性跛行症状为主、无明显腰椎不稳者,采用椎板开窗减压术(单纯减压组);27例明确存在腰椎不稳/腰椎滑脱或术中需要手术切除小关节突、椎板范围较大发生继发性不稳者采用经椎间孔入路椎间融合内固定术(TLIF)(融合内固定组)。采用日本骨科协会(JOA)评分和疼痛视觉模拟评分法(VAS评分)评估手术的临床疗效。结果:39例患者均完成手术。12例患者发生围手术期并发症,单纯减压组3例(肺炎1例,尿路感染1例,肺炎合并术后贫血1例),融合内固定组9例(肺炎3例,硬膜撕裂、尿潴留、心律失常、术后贫血、术后认知功能障碍各1例,尿路感染合并认知功能障碍1例),均经保守治疗后好转;无围手术期死亡病例。单纯减压组JOA评分由术前的10.8±2.3分改善至末次随访时的19.0±4.8分,融合内固定组JOA评分由术前的11.8±2.2分改善至末次随访时的21.8±3.4分,两组患者末次随访时与术前比较均有统计学差异(P0.05)。两组患者末次随访时的腰痛和腿痛VAS评分(单纯减压组3.2±1.7分和3.5±2.1分,融合内固定组3.0±1.2分和2.9±1.2分)与术前(单纯减压组7.4±0.9分和7.8±1.0分,融合内固定组7.4±1.7分和7.7±1.1分)比较均有统计学差异(P0.05)。结论 :对于高龄退行性腰椎管狭窄症患者,术前充分评估患者全身状况,积极处理合并疾病后,根据临床症状、体征及影像学资料,确定责任节段及致病因素,合理选择手术方式,可获得满意的疗效。     

Predictors of outcomes after posterior decompression and fusion in degenerative spondylolisthesis

No consensus has been reached regarding surgical management of degenerative spondylolisthesis. The optimal type of surgical procedure and surgical indications have not been precisely defined. In order to screen for predictors of outcome, we retrospectively studied patient outcomes after posterior decompression and fusion for isolated lumbar degenerative spondylolisthesis. Twenty-four consecutive patients (age range 50–78 years) underwent primary surgery for isolated lumbar degenerative spondylolisthesis. The surgical procedure consisted of posterior decompression and pedicle screw instrumented fusion using autogeneous bone graft, with or without interbody fusion. Clinical and radiologic status were assessed using the Beaujon functional score and plain AP and lateral radiographs. A multivariate analysis was used to correlate the functional score increase with surgical procedure modifications and preoperative clinical and radiologic features in order to determine which of them led to better results. Eighteen patients completed the evaluation. Six others were lost to follow-up after a minimum of 0.87 years. Combining all the results, the mean follow-up was 2.87 years. The Beaujon score was improved in the 24 patients (P<0.001), and fusion was successful in all cases. Additional interbody fusion and preoperative leg pain were significantly correlated with larger score increase (P=0.016 and P=0.003). Posterior decompression and fusion is successful in treating lumbar degenerative spondylolisthesis. From this study, circumferential fusion improves the outcomes and leg pain is a fair indication for surgery.     

微创经椎间孔椎间融合术治疗退变性腰椎失稳

目的对比传统开放与微创经椎间孔椎间融合术(transforaminal lumbar interbody fusion,TLIF)治疗单节段退变性腰椎失稳(degenerative lumbar instability,DLI)的疗效。方法回顾分析2007年3月-2009年5月收治的单节段DLI患者87例,分别采用传统开放TLIF(A组,45例)和微创TLIF(B组,42例)治疗。两组患者性别、年龄、病程、病变节段分布、腰椎合并疾病和单双侧症状的构成等一般资料比较,差异均无统计学意义(P>0.05),具有可比性。比较两组患者的手术创伤、全身炎性反应、临床疗效及椎旁肌损伤程度。结果两组患者均顺利完成手术,无术后并发症发生。患者均获随访,A组随访时间平均2.9年,B组平均2.8年。与A组相比,B组切口较小、术中出血量和术后引流量较少,但手术时间较长,差异均有统计学意义(P<0.05)。两组术后24 h外周血C反应蛋白、白细胞计数和肌型肌酸激酶以及术后6 d C反应蛋白比较,差异有统计学意义(P<0.05)。末次随访时,两组Oswestry功能障碍指数(ODI)及疼痛视觉模拟评分(VAS)均较术前明显改善(P<0.05);两组下肢痛VAS评分差异无统计学意义(P>0.05),而ODI及腰背痛VAS评分差异有统计学意义(P<0.05)。末次随访时,A组无腰背痛8例,腰背痛轻度25例,中度9例,重度3例;B组无腰背痛18例,腰背痛轻度18例,中度6例;B组腰背痛程度较A组轻(Z=—2.574,P=0.010)。A、B组多裂肌萎缩比率分别为37%±13%、15%±7%,差异有统计学意义(t=12.674,P=0.000)。A组多裂肌萎缩Ⅰ度18侧,Ⅱ度42侧,Ⅲ度30侧;B组Ⅰ度44侧,Ⅱ度32侧,Ⅲ度8侧;两组多裂肌萎缩程度比较,差异有统计学意义(Z=—4.947,P=0.000)。结论与传统开放TLIF相比,微创TLIF具有手术创伤小、术后全身炎性反应轻、椎旁肌损伤小及术后腰背痛程度较轻的优势,但手术时间较长。     

脊柱－骨盆矢状位参数及关节突关节角度对退变性腰椎滑脱的影响

目的：探讨脊柱-骨盆矢状位参数及关节突关节角度对退变性腰椎滑脱的影响及相关性研究。方法：以2016年7月至2019年9月确诊的120例L₄-L₅单节段退变性滑脱患者为观察对象（滑脱组）,以性别和年龄相匹配的120例L₄-L₅节段退变性椎管狭窄患者为对照（对照组）。通过影像学资料测量如下参数：骨盆入射角（pelvic incidence,PI）,骨盆倾斜角（pelvic tilt,PT）,骶骨倾斜角（sacral slope,SS）,腰椎前凸（lumbar lordosis,LL）,胸椎后凸（thoracic kyphosis,TK）,矢状面平衡（sagittal vertical axis,SVA）,L₄-L₅头侧关节突关节角,尾侧关节突关节角及小关节不对称性。比较两组患者参数的差异并对有意义参数行Logistic回归分析。对退变性腰椎滑脱患者关节突关节方向与脊柱-骨盆参数进行相关性分析。结果：两组患者在PI、PT、LL、SVA、头侧关节突关节角、尾侧关节突关节角差异有统计学意义（P<0.05）;Logistic回归分析发现PI、PT及头侧关节突关节角是腰椎滑脱程度的危险因素（P<0.05）。滑脱组头侧关节突关节矢状化与PI、PT呈现显著相关（P<0.05）。结论：高PI、PT及头侧关节突关节矢状化是腰椎滑脱的危险因素,并且关节突关节矢状化程度和大PI、PT密切相关。     

腰椎滑脱症的手术治疗体会

<正>2008年1月~2012年5月,我科手术治疗30例腰椎滑脱症患者,治疗效果良好,现总结报道如下。1材料与方法1.1病例资料本组30例,男15例,女15例,年龄39~68岁。腰椎滑脱部位:L519例,L47例,L34例。峡部崩裂性滑脱28例,退行性滑脱2例。滑脱分度:Ⅰ度滑脱24例,Ⅱ度滑脱6例,16例伴有椎间盘突出,26例伴有椎管狭     

退变性腰椎滑脱症的临床治疗

目的探讨退变性腰椎滑脱的治疗方法.方法经后路减压、椎弓根螺钉系统内固定、植骨融合术治疗退变性腰椎滑脱25例.结果术后19例滑脱完全复位,6例滑脱无明显复位但患者症状有明显改善.25例经6～24个月随访,治疗改善率为86.9%,无椎弓根钉断裂及滑脱加重.结论该方法效果满意,术中重点在减压,关键是为融合创造条件.     

退行性腰椎滑脱伴腰椎管狭症的手术治疗

目的探讨退变性腰椎滑脱伴椎管狭窄症的手术治疗。方法回顾性分析 84例退变性腰椎滑脱伴腰椎管狭窄症的手术治疗结果。其中男性 33例 ,女 5 1例 ;年龄 4 3～ 79岁 ,平均 5 6 .1岁 ;包括Ⅰ°滑脱 5 1例 ,Ⅱ°滑脱 33例。33例接受单侧或双侧椎板开窗减压术 ,5 1例接受全椎板切除减压、植骨融合椎弓根螺钉内固定术。结果 84例经过平均 5年 3个月的随访 ,两种手术方法疗效优良率分别是 90 .90 %、84 .2 7% ,两种疗效无显著性差别 (P >0 .0 5 )。手术并发症发生率为 9.0 9%、17.6 4 % ,亦无显著性差异 (P >0 .0 5 )。结论对于腰椎管狭窄症伴腰椎滑脱症手术适应症和减压范围要掌握恰当 ,二种手术方式减压均可以取得满意疗效。