MISS-TLIF技术治疗单节段Ⅰ、Ⅱ度退行性腰椎滑脱症的临床观察

目的：探讨运用MISS-TLIF（微创经椎间孔椎体间融合术）技术治疗单节段Ⅰ、Ⅱ度退行性腰椎滑脱症的临床效果。方法：本组共收治单节段Ⅰ、Ⅱ度退行性腰椎滑脱症36例,根据Mayerding分级,其中Ⅰ度滑脱22例,Ⅱ度滑脱14例。采用MISS-TILF技术联合椎弓根螺钉固定在Quadrant可扩张管道系统协助下行减压、复位、融合、固定。记录患者的手术时间、术中出血量、术后出血量、术后住院天数及并发症情况。术前、术后3个月、术后6个月及术后1年以VAS评分评估患者手术前后腰腿痛的程度,以ODI伤残指数（Oswestry disability index,ODI）和腰椎JOA（29分法）功能评分对腰椎功能进行评估,并计算改善率。结果：手术时间为85～165min,平均125min;术中出血145～680mL,平均285mL;术后出血（以负压引流球的引流量计算）25～125mL,平均70mL;术后住院天数5～19d,平均8.2d。随访时间12～26个月,平均18个月,术前JOA评分为（11.24±1.38）分,术后3个月JOA评分为（18.03±1.05）分,术后6个月JOA评分为（23.12±1.83）分。术前与术后比较差异有统计学意义（P〈0.05）。根据腰椎JOA评分标准计算改善率,其中优24例、良10例、可2例。结论：运用MISS-TLIF技术治疗单节段Ⅰ、Ⅱ度退行性腰椎滑脱症的手术安全、效果可靠。     

后路不同术式治疗腰椎退变性滑脱65例临床疗效比较

目的:比较几种不同后路手术方式治疗腰椎退变滑脱症的临床疗效。方法:65例患者根据是否可行内固定及融合方式分成A(单纯椎板减压+后外侧植骨)、B(椎弓根固定+后外侧植骨)、C(椎弓根固定+椎体间自体植骨)、D(椎弓根固定+椎体间融合+Cage)4组,采用ODI评分方法对患者术前术后的情况进行评估,VAS评分标准进行疼痛程度评估,SUK标准对患者手术前后的正侧位片及动力位片进行融合评估。结果:所有病例均获得1～2年随访,B、C、D 3组在腰椎稳定性及临床疗效方面均优于A组,D组在椎间高度、生理曲度维持方面均优于A、B、C 3组。结论:后路椎弓根螺钉内固定加椎体间Cage植骨融合是治疗腰椎退变滑脱的理想术式。     

Steffee槽式钢板治疗腰椎滑脱症

采用Ｓｔｅｆｆｅｅ槽式钢板治疗腰椎滑脱症共１２例，收到良好效果。滑脱度数在２５％～５５％之间，复位率９７％。手术要点：真性滑脱椎弓根钉进钉点靠横突，峡部裂要彻底切新，采用大块植骨．双侧同时复位。一般情况不切除椎板。因复位后可恢复脊柱的三柱结构，临床症状得以解除．骨质疏松是禁忌症。我们认为该钢板具有复位满意，固定可靠，促进融合等优点，是目前治疗腰椎滑脱症较为理想的方法。     

Long-Term Clinical and Imaging Results of Oblique Lateral Interbody Fusion for Degenerative Lumbar Spondylolisthesis: A Systematic Review and Meta-Analysis

The efficacies and safety of oblique lateral interbody fusion (OLIF) for degenerative lumbar spondylolisthesis (DLS) remains controversial, and long-term clinical efficacies in particular need to be explored. This study is designed accordingly, therefore, we searched PubMed, Embase, Scopus, Web of Science, Cochrane Library, ProQuest, OVID, and SinoMed for literature, regardless of publication date or language. Taking 12 months after operation as the shortest limit, the outcome measures were extracted, including visual analog scale (VAS), Oswetry dysfunction index (ODI), Japanese Orthopaedic Association (JOA) score, intervertebral disk height (IDH), foraminal height (FH), lumbar lordosis (LL), segment lordosis (SL), slip ratio, and incidence of surgical complications. Meta-analysis was performed by RevMan 5.4 and Stata 16.0, and results were expressed with MD and 95% CI, and two-sided p-values with p < 0.05 being statistically significant. In total, 17 clinical studies (n = 689 patients) were screened, with an average patient age of 63.4 years. Our study revealed that VAS decreased by 4.55 (low back pain) and 5.46 (leg pain) points, respectively. And ODI score decreased by an average of 33.82% while JOA score increased by an average of 11.56 points. In terms of imaging indicators, mean IDH and FH increased by 4.18 and 4.91 mm, mean LL and SL improved by 9.22° and 2.46°, respectively. Besides, mean slip ratio decreased by 10.45%. The incidence of complications was statistically analyzed in 18 studies, with a rate of 4%–54% and an overall incidence of 19%. To sum up, our study was the first to focus on the long-term efficacies of OLIF treatment for DLS, and to provide further clinical evidence. However, long-term follow-up multicenter randomized controlled trials are still needed for further evaluation.     

腰椎滑脱症采用SSRF内固定的生物力学评价

目的 探讨腰椎滑脱症采用新型SSRF内固定器的生物力学特性。方法 采集5具新鲜人尸腰椎标本，利用实验应力分析方法，测量腰椎滑脱采用SSRF内固定器固定后的脊柱强度，刚度和稳定性，并与Steffee钢板、MSF内固定器、SF内固定器进行对比。结果 采用SSRF内固定，其平均强度和刚度均比正常标本高，其平均强度、刚度和极限强度均比Steffee钢板、MSF内固定器、SF内固定器高，充分说明本器械在滑脱固定方面是有效的，并占有较大的优势。结论 腰椎滑脱症采用SSRF内固定不但生物力学性能优越，而且固定坚强、安全、可靠。     

椎弓根及侧块螺钉治疗创伤性枢椎滑脱

目的:探讨创伤性枢椎滑脱的治疗方法,评价椎弓根及侧块螺钉联合治疗创伤性枢椎滑脱的疗效.方法:7例创伤性枢椎滑脱患者,男5例,女2例;年龄21～45岁,平均30.2岁.损伤按Levine-Edwards分类:Ⅰ型3例,Ⅱ型3例,Ⅲ型1例.对所有患者进行椎弓根和侧块螺钉联合固定,并对其临床疗效进行分析.结果:所有患者获随访,随访时间11个月～4年6个月,骨折均在术后3～4个月愈合,颈部旋转及屈伸功能恢复正常,无术后并发症及迟发性畸形发生.结论:椎弓根及侧块螺钉联合治疗创伤性枢椎滑脱是一个有效方法,C2椎弓根螺钉可使枢椎骨折获得良好的复位,C3侧块螺钉钢板则可使枢椎滑脱得到良好的固定.