腰椎滑脱手术复位问题的探讨

目的探讨腰椎滑脱手术的复位问题。方法66例腰椎滑脱患者,其中36例(治疗组)采用椎弓根螺钉内固定加椎体间、后外侧植骨及Cage应用治疗,30例(对照组)采用后外侧原位植骨融合手术治疗。对两组术前、术后和最终随访时的X线片测量结果、融合率、断钉率、JOA评分等进行综合评价。结果①治疗组能明显增加椎间隙高度、相对椎间隙高度,提高复位率,降低滑脱率;②治疗组能明显提高术后1年、2年骨性融合率,降低断钉率;③治疗组能明显提高术后JOA评分。结论①腰椎滑脱症手术时滑脱椎体应尽可能复位;②不能过分强调解剖复位,主张部分复位比较安全;③滑脱复位后,术后常出现复位的丢失,如何减少复位的丢失,是需值得重视的问题;④在此基础上彻底的减压是基础,坚强的骨性融合是关键。

Evaluation of Surgical Reduction of Lumbar Spondylolisthesis

Objective To investigate the treatment of lumbar spondylolisthesis with pedicle screw fixation and posterolateral lumbar fusion and posterior lumbar interbody fusion using cage.Methods 66 adult patients with lumbar spondylolisthesis were divided into two groups.36 adult patients in the treatment group were treated with pedicle screw fixation and posterolateral lumbar fusion and posterior lumbar interbody fusion using cage.30 adult patients in control group were treated with posterolateral lumbar fusion without pedicle screw fixation and cage.Results Comparing with those in the control group and pre-operation,the patients in the treatment group obtained significant decrease of post-operative and follow-up slipping percentage,slipping angle and broken rate.Beside the heights of intervertebral space and relative intervertebral space,the fusion rate and JOA score were improved significantly.Conclusion Reduction should be taken as much as possible in the treatment of lumbar spondylolisthesis.However,the complete reduction is not always necessary.Fusion is critical and complete decompression is basic in the treatment of spondylolisthesis.