椎弓根钉棒系统加椎间融合器植骨融合治疗腰椎滑脱症的临床分析

目的探讨后路腰椎管减压、椎弓根钉棒系统复位、椎间融合器和小关节突间植骨治疗腰椎滑脱并腰椎管狭窄的临床疗效。方法1999年6月-2007年1月，对41例腰椎滑脱患者进行腰椎管减压、椎弓根钉棒系统复位内固定、椎间融合和小关节突间植骨的手术治疗。其中I度滑脱29例，Ⅱ度滑脱11例，Ⅲ度滑脱1例；L3,4滑脱4例，L4,5滑脱16例，L5S1滑脱21例；24例为峡部裂性，17例为退行性。结果随访12-38个月，平均23.6个月。41例中37例症状完全消失，优良率90.2％；29例I度滑脱完全复位，11例Ⅱ度和1例Ⅲ度滑脱6例完全复位，完全复位率87.8％；椎间高度由术前平均4.1mm恢复至术后11.7mm，且无高度丢失，39例椎间融合良好，椎间融合率95.12％。结论后路减压、椎弓根钉棒系统复位内固定、椎间融合和小关节突间植骨治疗腰椎滑脱，复位满意、固定牢靠、融合率高、临床效果良好。

Transpedicular screw fixiation system combined with interbody fusion and bone graft for lumbar spondylolisthesis

Objective To investigate the clinical outcomes of a combined treatment of spinal canal decompression with posterior approach, reduction with transpedicular screw fixiation system, interbody fusion Cage and bone grafting for spondylolisthesis associated with spinal stenosis. Methods Fourty-one cases of lumbar spondylolisthesis underwent canal decompression with posterior approach, reduction with pedical screw and rod system, interbody fusion Cage and bone grafting between facet joint. The degree of condition was degree I spondyolisthesis （n=29）, degree Ⅱ spondyolisthesis （n=11）, and degree Ⅲ spondyolisthesis （n=1）. The onset site was L3,4 spondyoiisthesis （n=4）, L4,5 spondyolisthesis （n=16）, and L5S1 spondyolisthesis （n=21）. The classification was spondylolysis type （n=24） and degenerative （n=17）. Results All patients were followed up for 12 to 38 monthes, 23.6 months in average. Thirty-seven patients reported that primary symptoms disappeared completely, and the excellent rate is 90.2%.The patients with degree I spondyolisthesis, 11 patients with degree Ⅱ and 6 with degree Ⅲ spondyolisthesis also reported complete reduction. The complete reduction rate was 87.8%. The intervertebral height increased from 4.1mm to 11.7mm, without height loss. Thirty-nine patients reported good infusion, and the intervertebral infusion rate was 95.12%. Conclusions The combined treatment of spinal canal decompression with posterior approach, reduction with pedical screw and rod system, interbody fusion Cage and bone grafting brings good reduction, fixation, infusion rate and clinical outcomes.