单枚融合器附加椎弓根螺钉系统在腰椎滑脱治疗中的应用

目的探索以单枚椎间融合器后斜向植入附加椎弓根螺钉系统内固定的后路腰椎椎体间融合术治疗腰椎滑脱症.方法1997年7月～2000年8月,我们收治了各类腰椎滑脱症65例患者(男32例,女33例.年龄28～58岁,平均43岁).其中,峡部型滑脱症(Ⅰ～Ⅱ°)26例,退行性滑脱症25例,腰椎后路减压术后滑脱症7例,发育不良性腰椎滑脱症5例,外伤性滑脱症2例.均有一年以上的下腰痛和/或下肢根性症状且保守治疗无效.所有患者均在减压的基础上行病变节段的单枚螺纹式椎间融合器(BAK)的后斜向植入并附加用椎弓根螺钉系统内固定.结果65例中有59例平均随访达18月,皆达到临床融合.临床效果评价优42例,良14例,无改善3例,差0例.患者主观评定满意41例,基本满意15例,可3例所有患者均无融合器的移位及椎弓根螺钉松动,患者主观满意率93%.结论经侧后方斜向植入单枚螺纹状椎间融合器并附加椎弓根螺钉内固定的后路腰椎椎体间融合术式能充分完成后路减压,并能保证可靠的融合,适用于滑脱程度严重、滑脱倾向大的患者,不失为一种比较理想的治疗各种腰椎滑脱症的术式.

Lumbar Spondylolisthesis Treated with Posterior Lumbar Interbody Fusion(PLIF) Using One Diagonal Fusion Cage with Transpedicular Screw/Rod Fixation

Objective: To determine if PLIF can be accomplished by utilizing single diagonal fusion cage supplemented with transpedicular screw/rod instrumentation in treatment of lumbar spondylolisthesis. Methods: Sixty five patients with lumbar spondylolisthesis underwent a PLIF using one single fusion cage (BAK) inserted posterolaterally and oriented counter anterolaterally on the symptomatic side with unilateral facetectomy, and with same level supplemental transpedicular screw/rod fixation. Patients (28 to 58 years of age) had at least 1 year of low back pain and/or sciatica, and a severely restricted functional ability. The inclusion criteria were lumbar isthmic spondylolisthesis of 1 to 2 grade (n=26),lumbar degenerative spondylolisthesis (n=25),post laminectomy lumbar spondylolisthesis (n=7),lumbar congenital spondylolisthesis (n=5) and lumbar traumatic spondylolisthesis (n=2). Results: All these 59 patients were followed up meanly 18 months. All achieved successful radiographic fusion at 12 to 18 months Clinical results at 2 years, 42/59 patients were excellent, 14/59 were good, 3/59 fair, and no poor clinical results. No implant fractures or deformities occurred in all patients. Conclusion: PLIF using diagonal insertion of single threaded cage with supplemental transpedicular screw/rod instrumentation enables sufficient decompression and solid interbody fusion to be achieved while maintaining a minimal invasive to the posterior spinal elements. It's a clinically safe, easy and economical technique of PLIF to treat lumbar spondylolisthesis.