椎弓根螺钉固定结合单枚椎间融合器治疗腰椎滑脱疗效分析

目的：探讨后路椎弓根螺钉内固定结合经椎间孔单枚椎间融合器（ Cage ）融合治疗腰椎滑脱症的临床疗效。方法：从2009年11月～2013年9月，共收治61例腰椎滑脱症患者。其中男性19例，女性42例；年龄42～68岁，平均54岁。按Mey-erding分级：Ⅰ度滑脱20例，Ⅱ度30例，III度11例；L3椎体滑脱6例，L4椎体30例，L5椎体25例；峡部裂性腰椎滑脱21例，退变性腰椎滑脱40例。采用后路减压，复位，椎弓根螺钉固定，经椎间孔单枚椎间融合器（ Cage）融合进行手术治疗。手术中注意保护棘突，棘间及棘上韧带，术后3天复查X片后佩带腰围下床。根据腰痛视觉模拟评分（VAS）和JOA下腰痛评分系统（15分）评价手术前、后临床症状、体征及括约肌功能进行临床效果评估。结果：术后随访3～26个月，平均11．5个月。随访X线片显示椎体间植骨融合良好，内固定系统无松动和断裂，无明显腰椎不稳征象。复位后的滑脱椎体无丢失。术前腰腿痛VAS评分8．4分，术后2．3分，术前JOA下腰痛评分系统平均8．6分，术后22分。结论：椎弓根螺钉内固定结合经椎间孔单枚椎间融合器（ Cage ）融合手术治疗腰椎滑脱症通过两侧开窗减压，既能解除神经组织的压迫，又保留了后侧韧带复合体的完整性，能有效的保护椎管内神经组织，从而在很大程度上维持了腰椎正常的生物力学基础，减少了创伤。是一种疗效确实、具有复位可靠、远期稳定性确切的手术方法，临床治疗效果满意。

The Analysis of the Effects of Lumbar Spondylolisthesis with Pedicle Screw and Monocage

Obje ctive：To evaluate the effects of the lumbar spondylolisthesis treated by pedicle screw combined with monocage . Methods：From November 2009 to September 2013, there were 61 patients （19 men and 42 women） with lumbar spondylosisthesis. The age was between 42 to 68 with an average of 54.The preoperative pathogenesis included isthmic spondylolisthesis （n=21） and de-generative spondylolisthesis （n=40）.The involved levels were L3 of 6 cases, L4 of 30 cases and L5 of 25 cases.According to Meyer-ding standard, all cases were classified into 20 cases of I degree, 30 cases of II degree and 11 cases of III degree.All patients under-went decompression, reduction, pedicle screw system fixed,and intervertebral space fusion by monocage .The clinical effects were e-valuated according to Visual Analog Scale （ VAS） and JOA scoring system.Results： All the patients were followed up from 3 to 26 months with an average of 11.5 months.All the operated segments achieved fusion standard and no broken screw or cage dislocation oc-curred.Visual Analog Scale （VAS）, JOA showed statistical significance between perioperation and postoperatively （ p 〈0.05）.Con-clusions：Applying the posterior pedicle screw internal fixation combined with interbody threaded fusion cage may achieve synergism in the treatment of lumbar vertebral spondylolisthesis.It serves as a solid internal fixation, offers a satisfactory reduction and improves the fusion rate of the spine .This is an ideal procedure and worthy of being recommended as a method for the treatment of lumbar vertebral spondaylolisthesis.