延长固定节段结合短节段融合在中重度腰椎滑脱治疗中的应用

目的探讨延长固定节段结合短节段融合在中重度峡部裂型腰椎滑脱治疗中的手术技巧及疗效。方法对36例中重度峡部裂型腰椎滑脱患者行后路减压复位、椎间植骨融合,并包括滑脱椎近端相邻椎的延长节段钉棒系统固定术。通过影像学资料评估复位及植骨融合情况;采用JOA及VAS评分评价治疗效果。结果患者均获得随访,时间16~39个月。滑脱复位率91.8%~95.2%;椎间隙高度由术前4.7 mm±2.1 mm恢复至术后10.5 mm±2.4 mm;植骨融合率100%;JOA评分:术前7.9分±2.1分,术后3个月17.3分±3.9分,末次随访时24.5分±2.0分;VAS评分:术前7.5分±2.0分,术后3个月3.1分±1.4分,末次随访时1.8分±0.9分。参照JOA和VAS评分评价疗效,优20例,良13例,可2例,差1例,优良率91.7%。随访期间滑脱复位率及椎间隙高度无明显丢失。均无滑脱畸形加重,内固定松动,断钉断棒,感染及神经损害加重等现象。结论延长节段固定结合短节段融合治疗中重度峡部裂型腰椎滑脱症,可以达到理想的复位固定效果和可靠的骨性融合,临床疗效满意。

Extensive segment fixation with short segment fusion in the treatment of moderate or severe isthmic spondylolisthesis

Objective To investigate the effect of extensive segment fixation with short segment fusion in the treat-ment of moderate or severe isthmic spondylolisthesis. Methods 36 patients with isthmic spondylolisthesis were trea-ted by extensive segment fixation and posteriolateral interbody fusion （ PLIF） . The redution and fusion were investiga-ted by imaging data. JOA and VAS scores were used to access the therapeutic effect. Results All patients were fol-lowed up for 16-39 months. The reduction rate of spondylolisthesis was 91. 8% -95. 2%, the intervertebral disc height improved from 4. 7 mm ± 2. 1 mm to 10. 5 mm ± 2. 4 mm. The rate of bony fusion was 100%. JOA scores im-proved from 7. 9 ± 2. 1 （ preoperative） to 17. 3 ± 3. 9 （ postoperative 3 months） ,at final follow-up, it was 24. 5 ± 2. 0;VAS scores decreased from 7. 5 ± 2. 0 （preoperative） to 3. 1 ± 1. 4 （postoperative 3 months）,at final follow-up, it was 1. 8 ± 0. 9. According to JOA and VAS, 20 cases were excellent, 13 good, 2 fair, 1 poor,with the excellent-good rate of 91. 7%. No significant loss of spondylolisthesis reduction and disc height occurred. No complications was found such as aggravated formation, fixation broken, infection, aggravated neural injury, et al. Conclusions Exten-sive segment fixation with short segment fusion in the treatment of moderate or severe isthmic spondylolisthesis have anvantages such as ideal reduction and rigid fixation, reliable bony fusion. The clinical therapeutic effect is satisfied.