腰椎滑脱症不同手术治疗方式的临床比较

目的]通过对151例腰椎滑脱症手术植骨治疗病人的回顾性临床分析,探讨有关腰椎滑脱症的手术适应证、手术植骨方式选择及治疗效果。方法]依据病人情况分别采取以下4种术式,A组:后路钉棒系统固定单纯椎板植骨融合术21例,均Ⅰ度滑脱。B组:减压、钉棒系统固定、复位、经椎管椎体间植骨融合术46例,Ⅰ度20例,Ⅱ度26例。C组:减压、钉棒系统固定、复位、经关节突椎间椎板植骨融合术29例,Ⅰ度6例,Ⅱ度16例,Ⅲ度7例;D组:减压、钉棒系统固定、复位、经关节突椎间、横突间椎板植骨融合术55例,Ⅰ度4例,Ⅱ度41例,Ⅲ度10例。结果]随访8个月～6年,平均3年7个月,A组滑脱复位率63.22%,融合率76.12%,腰痛JOA评分改善率90.33%;B组滑脱复位率93.41%,融合率93.48%,JOA评分改善率84.61%;C组滑脱复位率90.54%,融合率94.11%,JOA评分改善率77.58%;D组滑脱复位率92.49%,融合率98.00%,JOA评分改善率79.64%。结论]对腰椎滑脱应依据滑脱程度、临床症状、病人全身情况选择相应的手术方式。

Clinical comparison of different surgical procedures for the treatment of lumbar spondylolisthesis

Objective] Through the analysis of 151 cases of lumbar spondylolisthesis treated with surgical and bone graft procedures,the different types of surgical and bone graft procedures were evaluated.Methods]Patients with spondylolisthesis were divided into 4 groups based on their pathology and different surgical and bone graft procedures were used accordingly:group A was consisted of 21 patients with spondylolisthesis ofⅠdegree,they were treated with reduction of sliding vertebra,posterior internal fixation by nail-stick system and lumber vertebral lamina fusion.Group B was consisted of 46 cases with spondylolisthesis ofⅠdegree(20 cases) andⅡdegree(26 cases),they were treated with decompression,reduction of sliding vertebra,posterior internal fixation by nail-stick system and the intraspinal vertebral body fusion.Group C was consisted of 29 cases with spondylolisthesis ofⅠdegree(6 cases),Ⅱdegree(16 cases) andⅢdegree(7 cases),they were treated with decompression,reduction of sliding vertebra,posterior internal fixation by nail-stick system and the intervertebral body and vertebral lamina fusion through the zygopophysis.Group D was consisted of 55 cases with spondylolisthesis ofⅠdegree(4 case),Ⅱdegree(41 cases) and Ⅲ degree(10 cases),they were treated with decompression,reduction of sliding vertebra,posterior internal fixation by nail-stick system and the intervertebral body,transverse and vertebral lamina fusion through the zygopophysis.Results]The patients were followed up from 8 months to 6 years with an average of 3 years and 7 months.The reduction rate of spondylolisthesis,fusion rate and improving rate of JOA scores were respectively 63.22%,76.12% and 90.33% in group A,93.41%,93.48% and 84.61% in group B,90.54%,94.11% and 77.58% in group C,and 92.49%,98.00% and 79.64 in the group D.Conclusion]The concrete surgical techniques for treatment of spondylolisthesis should be selected according to the extent of spondylolisthesis,clinical presentation and general properties of the patient.